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Herbal medicines put into context

BMJ 2003; 327 doi: (Published 16 October 2003) Cite this as: BMJ 2003;327:881

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Herbal medicines put into context: Indian experience on using herbal medicines in AIDS therapy.

To The Editor,

Excellent review by Ernst on Herbal medicines, published in the BMJ
(18 October, page 881). He has very successfully conveyed his views in
right context. It is true that herbal medicines (known as Ayurvedic
medicines in India) also have side effects but as Ernst correctly mentions
that number of patients experiencing these side effects are so minimal
that benefits of using these medicines clearly outweigh the harms
associated. The Ayurvedic system of treatment in India is one of the
oldest in the world. However, lately the modern medicine overpowered the
ancient system. Recently, Indian government has taken a serious view to
revamp this poor friendly treatment system. India is rich source of
indigenous herbs and these are easily available to local folks at cheapest
cost, albeit used irrationally several times. However, the biggest reason
why this pathy could not be so popular, because not much evidence based
scientific studies were carried out and these medicines were used only as
a traditions, rather than well researched system of medication.
Nevertheless, now several scientists in India have started working on
these drugs. We also carried out a preliminary study on polyherbal
medication in HIV infected patients to potentiate the immune system of
these patients.

Thirty seven confirmed HIV positive persons were recruited in this
study. Their written consent was obtained. Their baseline haematological,
biochemical and serological parameters were recorded and those with severe
organ damage and opportunistic infection were excluded from this study.
Patients with CD4+ cell counts of less than 100/ml were also not included.
All patients were treated with a polyherbal Ayurvedic formulation of
herbal medicines (Immu-21®). Two gelatine capsules were given twice
daily with liquid just before or after the meals. Each capsule
contained Tinospora cordifolia 100 mg, Withania somnifera 100 mg, Ocinum
sanctum 100mg and Emblica officinalis 100 mg. The patients on Ayurvedic
medicine were counselled and given free choice (in the consent form) to
stop Ayurvedic medicine and start the anti-retroviral drugs at any stage
of the study. Thirty other patients who were only on antiretroviral
therapy comprising of 300 mg AZT + 150 mg 3TC bid were included in the
control group. After every 3 months repeat CD3+, CD4+ and CD8+ counts and
other biochemical parameters were done on all patients. Patients were
followed upto 2 years.

Of the 37 patients on Ayurvedic medicine, 25 were males and 12
females. The patients aged as young as 7 years and as old as 51 years
with mean age of 31.89 + 11.1 yr. The age of control group was also
ranged 15-55 yrs with mean age of 33.5 + 9.2 yr. During the follow-up
period of 2 years, 6 patients (16.2%) died and 7 (19.0%) lost the follow-
up after 6 months and another 6 after 12 months for reasons other than
the side effects of Ayurvedic medication. Thus, 18 patients successfully
completed the two years drug trial In control group 3 (10%) patients died
but 9 (30%) patients lost the follow because they could not afford the
cost of treatment, as most of the newly HIV infected patients in India
are below poverty line.2 The average basal CD4+ cell count at -3 months
(before the institution of treatment) was 331.6/ml which declined @
6.5/ml /month and reached 311.9/ml when the treatment was initiated (0
day). All except two patients treated with herbal medicine showed increase
in their CD4+ as well as CD8+ cell counts. After first three months the
decline stopped and after 6 months of treatment the mean CD4+ cell count
rose to 407.6/ml. After one year CD4+ cell count was 473.4/ml. The maximum
increase recorded was from 120/ml to 528 /ml CD4+ in a male patient and
from 287/ml to 930/ml in a female patient after 2 years. However, no
viricidal effect ( viral load monitoring done only in 5 patients) was
observed in Ayurvedic treatment group, neither it was aimed. In cases of
anti-retroviral treatment group, the rise in CD4+ cell count was less
significant but sharp. In this group the mean CD4+ cell counts rose from
110 /ml CD4+ to 320 /ml CD4+. The number of side effects were
significantly more in antiretroviral treatment group than study group. The
control group had nausea, vomiting and rash in 10% cases while only 2 (5%)
of the 37 patients treated with herbal medication had skin rash which
subsided on breaking the treatment for two weeks. The treatment could
again be started uneventfully. This pilot study indicated a great
potential in the Indian herbal preparation to keep the immune system
balanced and check the deterioration in the health of HIV infected
persons.3 It was proposed that if combination of Ayurvedic medication with
antiretroviral therapy is given to HIV infected patients, the results will
be far more impressive.

Sarman Singh, MD

Head, Division of Clinical Microbiology,
Department of Laboratory Medicine,
All India Institute of Medical Sciences,
New Delhi-110029 (India).


1. Ernst E. Herbal medicines put into context. BMJ 2003;327:881-882

2. Singh S. AIDS Care in India. AIDS Reader 1997; 7: 100-106.

3. Singh S, Kumari Veena, Singhal S, Singh N. An Indian herbal
immunomodulator: Highly effective in the treatment of HIV/AIDS.
Proceedings of 6th International Conference on AIDS in Asia Pacific,
Melbourne, Australia., October, 2001. Abstract [WePo 1254].

Competing interests:
None declared

Competing interests: No competing interests

17 October 2003
Dr. Sarman Singh
Professor of Clinical Microbiology
All India Institute of Medical Sciences, New Delhi-110029 (India)