Artemisia annua Training Manual - Malaria Defeated
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Artemisia annua Training Manual
Transcript of Artemisia annua Training Manual - Malaria Defeated
Artemisia annua
Training Manual
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Welthungerhilfe Rwanda, Artemisia Training Manual MzB September 2011
Table of Contents/ Training schedule; Training for approx. 2. 5 hours
Time Training tools Remarks
1. Introduction 1.1. Objective of the training
15 Min Poster of medicinal plants
2. The plant
15 Min Illustrative material: plants, photos
2.1. Ideal growing conditions for Artemisia A3
5 Min
3. Propagation
30 Min Soil, pots, knife, scissors, water,
simple roof material
Demonstration of propagation best in the field/plantation with fresh Artemisia plants
4. Planting 10 Min Seedlings, water Demonstration best in the field; preparation of planting
hole
5. Harvesting and Processing 20 Min Knife, drying frame with wire; sieve,
plastic bags, container
6. Tea preparation 15 Min Cooking pot, measuring jar and
photo dose, glasses
7. Dosage 15 Min To be distributed as hand out
8. Malaria treatment 15 Min
9. Immune system – HIV/ AIDS 10 Min Topic can be skipped, if not relevant for particular group
of trainees
10. References/ further contacts
11. Hand-outs English1
12. Hand-outs Kinyarwanda
1.1. Objectives of the training: at the end of the training participants: have an understanding of the importance of herbal medicine, understand the connection between Coartem ® and the active ingredients of Artemisia annua, are able to plant, cultivate, propagate and harvest the plant, process the leaves and apply the
tea, are motivated to introduce the medicinal plant in their respective area/ environment and
convince others, are able to train others, e.g. family/ community/youth club members.
1 Source: anamed (Action for Natural Medicine) Schafweide 77; 71364 Winnenden, Germany; www.anamed.net Dr. Hans-Martin Hirt: [email protected]; Dr. Keith Lindsey: [email protected]
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1. Introduction
Artemisia annua, also known as Sweet Wormwood is a common type of wormwood that is native to Asia, but grows naturally throughout the world.
Artemisia was used by Chinese herbalists before 2000 years already to treat fever. It had been forgotten for long, but was rediscovered in the 1970's, when the ‘Chinese Handbook of Prescriptions for Emergency Treatments’ was found.
In 1971, scientists demonstrated that the plant extracts had antimalarial activity. In 1972 the active ingredient Artemisinin was isolated and its chemical structure described. In
the meantime, it has been produced semi-synthetically as an antimalarial drug.
Medicinal use as Anti-Malarial In 1993: approval of Artemisinin as medicine against Malaria. It has an anti-parasitic effect
against Plasmodium falciparum (Malaria tropica), P. ovale, P. malariae and P. vivax. In 1997: introduction to East Africa. Since then, Ministries of Health in different countries have
changed their first line anti-malaria drug to the Artemisinin-based combination treatment (ACTs) - Coartem® - for uncomplicated falciparum malaria.
ACTs are too expensive for many people who seek treatment. Tens of millions of children remain unprotected and 33 countries had coverage of less than 40% in 2007.
It is highly recommendable to provide the Artemisia annua plant to remote communities that do not have any other treatment for Malaria. Health care infrastructure is lacking in most of the worst Malaria affected areas, making it impossible to distribute drugs to those who most need them.
Artemisia tea can be effective as a “first aid” measure to keep the patients alive and prevent deterioration while they travel to the health centre. It is simple to use and is a much cheaper alternative to commercial pharmaceuticals.
Treatment of Malaria solely with Artemisia tea infusion has been proven in innumerable cases with a cure rate of > 90 %.
The clinical efficacy is characterized by an almost immediate onset and rapid reduction of parasitemia.
Furthermore, Artemisinin and many of its analogues possess not only anti-parasitic effect in the Malaria treatment, but also immuno-modulation effects, and antitumor activities.
Through the presence of other active ingredients, the herbal tea infusion can be considered as ‘a natural Artemisinin combination therapy’, which prevents the development of parasite resistance.
Artemisia can play an extraordinary role in our future, because
1. it shows potential to cure millions of people who suffer from Malaria with an easily available ingredient,
2. it can be used for large commercial production as well as for home growing medication, 3. it offers in various East African countries already a good income for farmers as cash crop and
thus has a positive effect on poverty reduction, 4. there are first promising results by administering it to people with HIV/ AIDS.
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2. The plant
Objectives: at the end of this session participants can describe the plant botanically, know about its active ingredients, know about ideal growing conditions, can distinguish between healthy plants and plants which grow under sub-optimal conditions.
Characteristics of the plant: Botanically it belongs to the ‘Compositae’-family. It is a weedy annual plant. Its height ranges from 1 to 2 meters. The plant produces a single stem that are covered with fine, silky grey-green hairs, alternating
bushy branches, and alternating leaves which range 2.5–5 cm in length.
It has fern-like leaves, bright yellow flowers, and a camphor-like scent.
It contains approximately 150 different active components, many of them with anti-malarial activity.
The main active ingredient is Artemisinin, which is found in the leaves, stems, and inflorescences, and it is concentrated in the upper portions of plant within new growth.
Different genetic varieties contain widely varying amounts of Artemisinin. In 1995 a Hybrid variety A3 (i.e. => a controlled-crossed-breeding) has been introduced (produced by Mediplant Inc., Conthey, Switzerland), which contains up to 1.4% Artemisinin.
Further research with plants of low Artimisinin content has shown the same therapeutic effect than achieved with the hybrid; some Artemisia species, such as A. absinthium, A. abrotanum and A. afra have antimalarial activity even without containing Artemisinin.
Healthy plant Plant under sub-optimal growing conditions with poor soil and/or shortage of water starts early flowering
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2.1. Ideal growing conditions for Artemisia A3
Objectives: at the end of the session participants have understood theoretically best growing conditions for a successful cultivation of Artemisia
annua, can repeat precise data in a post-training-test.
Temperature: 18-25 ° C, low night temperatures.
Altitude: min. 1,000 – 1,500 m above sea level.
Precipitation: 700 – 1,000 mm p.a., necessary at time of planting.
Soil: at least moderate fertility, pH >5.5.
Sensitive to salty environment/ soil: cultivation only possible in 30 km distance from sea/ ocean.
Day length: A3 does not depend anymore on day length, high intensity of light required.
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3. Propagation
Objectives: at the end of the session participants have understood theoretically how to propagate the plant, know how to prepare the soil and seed bed, are able to practically perform the propagation precisely following theoretical knowledge and
the law of nature. a) Propagation via seeds
Preparation of soil: sieve available soil until fine texture is achieved – very important as seeds are extremely tiny (1 seed => 0.07 mg/ 1g of seeds => 12,000 seeds),
mix with dried animal dung at least one week before planting, sow seeds in seed bed without covering with soil and put it in the sun (18-30 °C),
Preparation of seed bed
b) Propagation via cuttings
Once you have one plant raised from seeds, you are independent in producing cuttings/ new plants.
Cuttings from the original A3 Hybrid plant always deliver the same quality than the mother plant
Preparation of soil: sieve available soil until fine texture is achieved and mix with dried animal dung at least one week before planting.
Cuttings should be taken from strong healthy plants, > 2 months old.
Use a sharp blade/ knife to cut a branch into pieces.
Each cutting has to have at least two nodes.
Remove all larger leaves from the lower node, but leave the small side shoot intact.
Stick cuttings into earth – at least 30 cm deep - roots will grow from lower node (after 2-3 weeks).
Cutting should be out of direct sunlight, e.g. construct a simple roof.
Regular watering – best from below - is very important.
Water the seed bed from below, water from above could destroy the tiny plants,
after 3-7 days first seedlings are visible, after approx. 10 days the seedlings can be
transplanted, ideal timing: sowing during dry season, plant
can then easily grow during rainy season and being harvested again during dry season.
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4. Planting
Objectives: at the end of the session participants understand the principles of planting theoretically and can perform practically, have gained enough knowledge and are practically able to plan, design and set up an Artemisia
plantation, know about positive and negative impact of intercropping.
Keep approximately 1 m distance between plants in plantations.
Regular watering is very important.
Cover the soil with organic material, particularly during dry season to avoid evaporation.
It is also recommended to plant A. close to the entrance of the house – it will prevent mosquitos to invade
Plantations Plants with positive interaction2
Rows
A Peanuts or beans Peanuts or beans A
A A
A Maize Maize A
Maize Maize Maize Maize
A Maize Maize A
Tephrosia Vogeli Tephrosia Vogeli A A
Peanuts and beans (or other legumes like Callientra) have a vegetation period of only 3-4 months, thus will be harvested earlier than Artemisia.
Maize protects the Artemisia plant, gives plenty of shade in hot regions, vice versa Artemisia protects Maize from insects through its strong scent.
If available, it is recommended to plant the legume Tephrosia Vogeli – a medicinal plant – between rows of A. plants; its roots grow vertically, while A. roots grow more horizontally. It continues growing after A. harvest for approx. 18 months up to a height of 3 m; the plant serves as organic fertilizer.
Attention: Do NOT grow Artemisia and sweet potatoes together.
After approx. 6 months the plant could start flowering – this is the time for harvesting.
2 anamed Seminar, Musoma, Tanzania, June11 – 18, 2006
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Plantations in East Africa3
Plant diseases
Hardly any disease affects the Artemisia plant.
Ants, mice, birds, chicken might peck at it; cover with mosquito-net, if available.
Only sick goats, suffering from nematodes, are instinctively eating it to get cured
The roots of this plant have been attacked by ants; a small ditch
around the plant filled with water or baby-/baking powder,
applied early enough, could avoid such damage.
3 All photos Welthungerhilfe Ethiopia and Rwanda
Perfect planting close to the housein farm yard
Intercropping with Ensete- „bananas“ in Ethiopia
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5. Harvesting and Processing4
Objectives: at the end of the session participants have understood the principles of optimal harvesting time, are able to practically perform the preparation for the drying process and the processing of
dried leaves, know which tools are necessary for best drying and processing and are able to provide them, have understood the importance of optimal drying conditions and close follow up of the process
Artemisinin content highest just before plant flowers.
Harvest time with first flower buds.
Strip the leaves from top to bottom (remove all stems).
Cut them into small pieces 1 cm long or leave as single branches
Dry them carefully at < 30 (high humidity: dry in the sun; low humidity: dry in the shade).
Leaves should be dried within 3 days.
Dried stalks indicate correct dryness of leaves: fold a stalk – if it breaks off at 90°, the material is dry; if it only bends, it needs more time to dry.
Rub the leaves through a sieve (mosquito grid).
Completely dried leaves should be kept in the dark, in air-tight container/ bag/ glass; humidity destroys the tea.
If hygrometer is available, measure humidity. Tea below 40% humidity will be best for approximately 1 year.
Good quality contains no stems and no flowers and shows a dark green colour. Attention: if the colour changes to brownish or yellowish, the tea becomes ineffective.
4 anamed, Germany
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6. Tea preparation5
Objectives: at the end of the session participants are sensitized about the importance of careful tea preparation, know about negative impact of unsuitable tools and/or practices, are able to practically perform the tea preparation, are inventive in applying Artemisia tea to children/ patients without appetite.
Boil required amount of water and let it cool down for few minutes.
Pour hot water over dried leaves and leave it to cool for 15 minutes.
Never boil infusion! Never prepare Artemisia tea in an iron or aluminum pot!
Do not filter the tea, leaves should be drunk as well, drink every 6 hours a quarter of the prepared tea, and finish the tea within 24 hours.
Optional: pulverize leaves and serve it in a sliced banana – particularly advisable for children.
Add sweetener (e.g. sugar/ honey) only to a portion (cup/ glass), never to the total amount boiled.
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7. Dosage6
Objectives: at the end of the session participants have got an orientation about the dosage of Artemisia tea application, have received the dosage chart as handout.
Attention:
- The body weight is more important than the age for measuring and applying the correct amount!
- There are not enough and clear research results on any side effects on foetal development during the first trimester of pregnancy. WHO- recommend therefore for pregnant women in the first trimester: only Quinine; in the second and third trimester: Quinine and A3 tea or Artesunate/ Coartem®
Body weight (kg) Age Amount of tea per day
(g)
Amount of water per day (ml)
(ml) 5-6 2 - 3 months 0,5 100
7-10 4 - 11 months 1 200
11-14 1 – 2 years 1,5 300
15-18 3 - 4 years 2 400
19-29 5 - 9 years 3 600
30-39 10 -11 years 3,5 700
40-49 12 -13 years 4 800
50 + adults 5 1,000
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8. Malaria Treatment7
Objectives: at the end of the session participants have understood the main signs of Malaria infection and the principles of its treatment, have been sensitized for the need of close care and follow up of a patient’s recovery.
Please note: Prevention is most important to eradicate the disease!
Improvement should be noticeable within 24 hours, the temperature should be brought down - otherwise it was not Malaria!
Administer the treatment for 7 days; better to continue treatment for 3-5 days to avoid relapse.
Exceptions: pregnant women, new born/ children <5 years, tumor patients have a reduced immunity; for these groups it is recommended to add bio-medicals.
If relapse happens and /or fever is still evolving start/ continue with Artemisia tea and add Fansidar or Chloroquine.
Always drink 2 more liters of water/ tea or soup (e.g. lemon grass, ginger or garlic) per day.
Plasmodium in blood cells should be depleted after 5-7 days,
WHO recommendation: Patient is considered as cured, if after 2 weeks no Plasmodium cells are detectable in blood cells, no fever and other symptoms.
7 anamed, Germany; see also anamed Malaria circular letter - January 2006: The Economics of Artemisia Cultivation
=> 5,700-8,500 Malaria treatments can be generated with one plant.
each Malaria treatment needs 35 g dried leaves
thus 1,000 plants produce 200-300 kg dried leaves...
each plant produces 200-300 g dried leaves...
provides approximately 1,000 cuttings...
1 motherplant...
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9. Immune System - HIV/ AIDS8
Objectives: at the end of the session participants have learned about more application possibilities of the herbal plant Artemisia, have understood the positive impact on the immune system in the context of HIV/AIDS
infection, know details of the application of Artemisia tea - also in combinations with other herbal plants
to improve the immune system, have been sensitised for the need of close care and follow up of a patient’s recovery/health
improvement.
Effect on immune system • Positive impact on general health condition. • Strengthening of immune system.
HIV/AIDS • First clear definite diagnose / CD4 counting is necessary. • Status of opportunistic diseases to be diagnosed. • Natural medicine is recommended when CD4 >400. • ARV and natural medicine can be combined. • Every three months repeated health check is important and necessary.
HIV/ AIDS treatment with natural medicine Recommendation / dosage:
• 5 g of dried leaves per day, regular administration for 1 month without interruption. • Thereafter application in intervals: 1 week Artemisia, 3 weeks without. • Health and nutritional condition should always be supported by balanced diet. • Supplementation with Moringa: 3x1 tablespoons /day.
Summary of herbs, which have positive impact on the immune system of AIDS patients: We recommend that patients use Artemisia tea and add two herbal medicines of the following:
1. Garlic (Allium sativum): Eat at least 3 cloves each day of raw garlic.
2. Artemisia annua: For the first month, drink 1 liter of tea using 5 g of dried leaves each day. Thereafter, for one week in every month, drink this amount of tea.
3. Neem (Azadirachta indica): 1-2 heaped teaspoonful of dried Neem leaf powder each week.
4. Lemon Grass (Cymbopogon citratus): Drink 2 liters of tea, using 1 handful of fresh leaves for
each liter, each day.
5. Aloe vera: Drink 1-2 tablespoonful of gel each day. This gel may be mixed with an equal amount of honey.
6. Lemon (Citrus limon): Drink the juice of 1 lemon each day.
7. Moringa oleifera: Prepare or buy Moringa leaf powder and add 1 heaped teaspoonful to the
food 3 times a day - every day of your life.
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10. References/ further contacts
1. Anamed contacts in Germany
- Coordinator: Dr. Hans-Martin Hirt Responsible for all anamed activities in Germany, the anamed artemisia programme, anamed publications and for coordinating anamed groups in Angola, Cameroon, D R Congo, India, Mozambique, Malawi, Nigeria and Tanzania. Schafweide 77; 71364 Winnenden, Germany; Email: anamedhmh(at)yahoo.de
- Dr. Keith Lindsey Responsible for the production of teaching materials, the web-site, editorial support with anamed publications and coordinating anamed groups in North-East Congo, Ghana, Kenya, Uganda and Zimbabwe. Berglenstr. 10; 71364 Winnenden, Germany; Tel: +49 7195 74572; Email: anamed(at)t-online.de
- Hannelore Klabes Wilhelmshöher Allee 337; 34131 Kassel; Tel: 0561/34610; Email: [email protected] www.artemisiafrau.de; https://picasaweb.google.com/Hannelore22/MalariaHilfeDireckt#
2. Contacts in Belgium: - IDAY (International Day of the African Childhood)
Jean-Jacques Schul Rue des Jambes 19 B-1420 Braine l'Alleud BELGIUM
Tel: 0032 2385 44 13; Fax: 0032 2 385 44 12; e-mail: [email protected] [email protected] ; www.iday.org
3. Further Contacts
1. RITAM-Research initiative on traditional antimalarial method (<http://www.giftsofhealth.org), Oxford, UK
2. RITAM Artemisia annua Task Force (www.gifts-ritam.org) 3. Department of Primary Health Care at the University of Oxford 4. „Iwerliewen fir bedreete Volleker“, Dr. Pierre Lutgen; (http://www.iwerliewen.org)
4. References
a) Natural Medicine in the Tropics I: Foundation Text (Third Edition)by Hans-Martin Hirt and Bindanda M´Pia
b) Natural Medicine in the Tropics II: Seminar Handbook by Hans-Martin Hirt and Keith Lindsey c) Natural Medicine in the Tropics III: Teachers Resource Kit d) Natural Medicine in the Tropics IV: AIDS and Natural Medicine (Third Edition) by Hans-Martin
Hirt, Keith Lindsey and Innocent Balagizi e) The Significance of Artemisia Tea Artemisia annua tea - a revolution in the history of tropical
medicine; updated 1st January 2009 f) Document ”Malaria: Artemisia annua” g) Anamed Malaria Programme Artemisia Starter-kit
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ANNEX 1: Planting
P L A N T I N G
Step 1 - Soil preparation
▪ Start at least 1 week before planting
▪ Prepare soil with organic material (cow dung,
leaves, branches)
▪ Soil must be loose and wet
Step 2 - Planting
▪ Keep approximately 1 m distance between
plants
Step 3 - Watering
▪ Daily watering is necessary
▪ Soil must be wet!!!
Artemisia annua
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ANNEX 2: Propagation with cuttings
C U T T I N G S
Step 1 - Soil preparation
▪ Start at least 1 week before planting
▪ Prepare soil with organic material (cow dung,
leaves, branches)
▪ Soil must be loose and wet
Step 2 - Cutting
▪ Use a sharp blade/ knife to cut a branch into
pieces
▪ Each cutting has to have at least two nodes
Artemisia annua
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C U T T I N G S
▪ Remove all larger leaves from the lower
node, but leave the small side shoot intact
Step 3 - Planting
▪ Stick cuttings into prepared earth
▪ Roots will grow from lower node
▪ Cutting should be out of direct sunlight, e.g.
construct a simple roof
Step 4 - Watering
▪ Daily watering is necessary
▪ Soil must be wet!!!
Cuttings can be planted elsewhere after they developed roots. Do not forget the necessary distance
between plants of approximately 1 m!
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ANNEX 3: Harvesting and Processing
H A R V E S T I N G & P R O C E S S I N G
Step 1 - Start of harvest
▪ Highest Artemisinin content just before plant
flowers
▪ Harvest time with first flower buds
▪ Be aware: Because Artemisia develops very
tiny, inconspicuous flowers, this needs
continuous attention!
Step 2 - Processing
▪ Strip the leaves from top to bottom, remove
all stems
▪ Cut them into small pieces 1 cm long.
Artemisia annua
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H A R V E S T I N G & P R O C E S S I N G
▪ Dry them carefully at < 30 °C (high humidity:
dry in the sun; low humidity: dry in the shade) ▪ Leaves should be dried within 3 days
▪ Rub the leaves through a sieve (mosquito grid)
Step 3 - Storing
▪ Completely dried leaves should be kept in the
dark, in air-tight containers/ bags
Good quality contains no stems & no flowers and shows a dark green colour.
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ANNEX 4: Application
A P P L I C A T I O N
Administer the treatment for 7 days
Step 1 - Water boiling
▪ Boil the required amount of water and let it
cool down for few minutes.
Step 2 - Tea preparation
▪ Pour the hot water over
dried leaves & leave it to cool for 15 minutes
▪ Never boil the infusion! Never prepare
Artemisia tea in an iron or aluminum pot!
▪ Drink every 6 hours a quarter of the prepared
tea,
▪ Finish the tea within 24 hours
▪ Do not filter the tea, leaves can be drunk as
well
Artemisia annua
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A P P L I C A T I O N
▪ Add sweetener (e.g. sugar & honey) only to a
portion (cup/ glass), never to the total
amount boiled.
Dosage
Body weight (kg) Age Amount of tea
per day (g)
Amount of
water per day
(ml)
11-14 1 – 2 years 1,5 300
15-18 3 - 4 years 2 400
19-29 5 - 9 years 3 600
30-39 10 -11 years 3,5 700
40-49 12 -13 years 4 800
50 + adults 5 1,000
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