Dosage vital in herbal medicine

By Ridlo Aryanto

YOGYAKARTA (JP): One afternoon, a patient is taken to experienced herbalist R. Broto Sudibyo in Mergangsan village in Yogyakarta. The 40-year-old Martono was in a very bad condition, too weak to walk by himself. He vomited in the herbalist's consulting room. When he urinated, his urine had blood in it.

The 82-year-old Broto, who is head of Bethesda hospital's traditional medicine clinic, said that Martono was drinking too much water from boiled mindi (Mindiceae sp) leaves.

To treat his hypertension, Martono should have only boiled seven mindi leaves, however, hoping for quicker results, he had boiled a bowl full of the leaves.

"Certainly, he became poisoned because, with that amount of leaves, it was as if he had been drinking a bottle of Baygon (mosquito repellent)," said Broto, adding that large amounts of the leaves are also effective as an insecticide.

The herbalist's neighbor, Mutmainah, once had a similar experience. This old woman, who has dozens of grandchildren, has a diabetes problem, but after drinking water taken from boiled Mahkota Dewa (Phaleria macrocarpa) fruit, she became unconscious. It was later discovered that she had boiled 10 of the fruit instead of one.

According to the herbalist, she should have only boiled one in three glasses of water until only a glass of water remained.

The fact is, too powerful herbal medicine can be harmful to your health.

"It is wrong to assume that traditional herbal medicine is always safe. The most important thing is to know the right amount to take," Broto said.

In the case of herbal medicine, as with any medicine, the right dosage is crucial.

A lecturer at the Gadjah Mada University's School of Pharmacy, Soegihardjo, agreed that correct dosage is important with traditional medicines.

"It is important to know the right dosage of a traditional medicine because some medicinal herbs have their own threshold for efficacy," Soegihardjo said.

"At a certain dosage, mimba can lower blood sugar levels but at a higher dosage, it will work differently," he warned.

Soegihardjo, who is head of the school's drug information and research center, suggested that the right dosage of traditional medicine, in grams, could be used.

He discouraged the use of household measurements, such as a handful and a pinch, to determine dosages.

"By measuring in grams, you will know the precise dosage. Furthermore, it will reduce the danger of an overdose to a minimum," Soegihardjo said.

The right dosage is also important regarding extracted traditional herbal medicine, he said.

Extracted traditional herbal medicine must be clinically tested to find out the right dosage because the extract is the active substance. "An excess of a gram is enough to make a patient pass out," he warned.

Other than in fine powder form, traditional medicine might be taken along with the dregs.

"If the medicine is in a very fine powder form, the efficacy of the substance of the herbal compound may be lost because it is not dissolved in water but in fat. That is why it (in powder form) must be taken along with the dregs. Inside the body, fat will help absorb this compound so that the efficacy of the medicine is absorbed by the body as well," Soegihardjo said.

Combination

In order to make sure the medicine works, herbal medicine cannot be taken alone.

For instance, a patient with kidney stones who is only given boiled kejibeling (Seriocalyx krispus) leaves will eventually vomit, as the leaves stimulate the stomach. To avoid this side effect, kejibeling must be taken along with wungu (Altervicia vulris) leaves, Broto said.

"In one plant, there is a compound to remove a side effect but there is also a substance to reinforce this side effect," Broto said.

The experts agreed that there is only a slight difference between toxicity and efficacy.

"If the dosage is right, it will have good efficacy, otherwise it will be toxic to the body," Soegihardjo said.

He said the same principle also applied to modern medicine. The only difference is, in the case of modern medicine, the side effects are under control.

"If a patient takes a modern drug and then he or she feels dizzy or itchy, he or she will simply report this to the doctor. But in the case of traditional medicine, people take it as a common practice," Soegihardjo said.