The History of Herbal Medicine in Nusantara

The lush white house looks exquisite, with neatly-arranged plants filling its 1,000 meter square land. Most of the plants there are labeled with their respective names and properties. A pharmacy stands right in front of the entrance, while an acupuncture practice room can be found inside the house. The place, known as Taman Sringanis or Sringanis Garden, was founded by writer Putu Oka Sukanta and his wife Endah Lasmadiwati. It is located in Kampung Cimanengah 29, Cipaku, South Bogor, and is open to anyone who is interested in herbal medicine.

"We provide services for those who come here on how to maintain family health so they won't depend on expensive medication," said Prasasti Baroto, the person in charge of the garden and plants at Taman Sringanis.

Garden managers are always ready to provide free information and consultation on health matters, as well as affordable self-produced herbal medicines which have received permits from the Ministry of Industry. "Herbs are concoctions, some of them are based on research and empirical results. We use the empirical ones," he said.

For thousands of years, people have been using plants to treat various diseases. Herbal remedies are the oldest recorded medicinal practice in history and remain an important part of medicine to this day.

The oldest documented evidence of herbal medicine is on the walls of the caves of Lascaux, France, which are thought to date back to 25,000 BCE. Written evidence followed a few thousand years later. The Sumerians, Ancient Egyptians and Chinese were the pioneers, with various records of herbal medicine being written in inscriptions and manuscripts.

Ancient Egyptians and Chinese recorded various types of plants along with their properties and usage since more than 3,000 BCE. The Egyptians combined medicine with culinary, while the Chinese consumed medicine separately from cooking. However, both the Egyptians and Chinese relied on plants from outside their region, especially from India and Nusantara.

Nusantara was an important player in the world of ancient medicine. Pepper, nutmeg, ginger, and cloves, which were part of the Nusantara's medicinal ingredients, were the most valuable trade commodities in the past.

Traditional vs Modern

A number of ethnic groups in Nusantara had their own traditional treatment systems, which were reflected on ancient manuscripts. In Bali, for example, there are the palm-leaf manuscript of Usada Buddha Kecapi about medicine, Usada Dalem  about ingredients and procedures for treating internal diseases, Taru Pramana about the efficacy of medicinal plants, and Usada Carekan Tingkeb that contains a collection of medicinal plants and their uses. Meanwhile, Java has Serat Primbon Jami Jawi containing 3,000 recipes of jamu or herbal medicine, Serat Primbon Jampi that includes a series of prayers, mantras, and natural medicines, and Serat Kwaruh that contains 1,734 Javanese herbal concoctions. Traditional medicine, especially in Java and Bali, was a blend of local wisdom and other medical methods such as Ayurveda from India and Unani from Arab.

The people of the Nusantara used to treat their own illnesses. In the market, there were spice dealers who not only sold the herbs but also gave instructions on the usage. Apart from getting them from Chinese agents, spice dealers usually got herbs from the rootmen dealers. "The latter searched for herbs in the forest and sold them, mostly to a tukang rempa-rempa, but sometimes they sold them themselves on the market," wrote Liesbeth Hesselink in Healers on the Colonial Market: Native Doctors and Midwives in the Dutch East Indies.

If the illness was severe and couldn't be treated by themselves, people went to shaman, healer, or  or sinshe, who would treat the patient with techniques, herbs and mantras. This tradition endured, in part because the shaman was usually a respected elder in a village or even a larger region.

Several Western explorers had described the importance of traditional medicine in Nusantara. Antonio Galvao, the Portuguese governor of Maluku, wrote in 1544, as cited by Anthony Reid in Asia Tenggara dalam Kurun Niaga 1450–1680 (Southeast Asia in the Commercial Period 1450-1680), "People here do not usually serve syrup, or stomach wash, let alone surgery. Their only medicines are the commonly known herbs and spices. They do not stitch wounds but treat them with burnt banana shoots, and while still hot, with oil."

Interested in Eastern medical techniques, Georg Everhard Rumpf, a German botanist, researched herbs and medicinal plants in Nusantara in the late 17th century. Descriptions of the uses of the various plants he researched were included in Herbarium Amboinense, published in 1690. He wrote that prickly spinach, for example, has properties for treating bile disorders and pain relief, while hibiscus is effective for smoothing and shining hair and skin.

However, negative responses were not uncommon, especially when the malaria and cholera epidemics that plagued Java in the 17th century could not be treated with traditional medicine. In addition, modern medical treatment from the West began to enter the Dutch East Indies. The establishment of hospitals in several places followed by the establishment of medical schools, smallpox vaccine testing, and the manufacture and use of drugs further emphasized the presence of modern medicine in Nusantara. Nevertheless, traditional medicine managed to survive and was not necessarily eliminated.

Then came what Liesbeth Hesselink calls the medical market. In the medical market, which in Indonesia began to be heavily popularized in 1985, patients are considered consumers and treatment is illustrated as a market where the laws of supply and demand apply. As a result, treatment becomes expensive, resulting in people looking for affordable and effective treatments.

"Herbal treatment is considered an alternative. If you don't get better from a doctor, you go to herbs," said Tito from Taman Sringanis.

A Legacy

Sariyah Soema Atmaja is an 80-year-old housewife from Bogor. She has experienced various health problems which all had been treated with herbal remedies. "If I have diarrhea, I eat the tops of guava leaves with rice. If I have high blood pressure, I'll eat bay leaves. If I have aches and pains, I squeeze binahong leaf water," said Sariyah, who was the former head of Wirawati Catur Panca Bogor.

Sariyah inherited this knowledge from her parents and passed it on to one of her children. "Herbs are definitely cheaper, and if we want, we can plant them ourselves. It's definitely more cost-effective. Medical treatment is more practical, but sometimes it causes side effects and costs a lot of money," Sariyah said.

Besides being passed through generations, herbal treatments spread by word of mouth. Various books have covered them, making it easier for people to make their own concoctions. Aware of the business opportunity, many companies have offered packaged herbal medicines or jamu which can be instantly brewed or drunk without the hassle of looking for plants or formulating them. In 1999, out of 723 traditional medicine companies, 92 were large industries, all were united under the Indonesian Herbal and Medicinal Business Association.

"Around the world, including Indonesia, the use of complementary and alternative medicine in the last 20 years has increased sharply, not only because of the 'back to nature' trend, but also because CAM is a source of health services that is easily available and affordable to the wider community," wrote Ning Hermanto and Ahkam Subroto in Pilih Jamu dan Herbal Tanpa Efek Samping (Choosing Jamu and Herbs Without the Side Effects). CAM refers to Complementary and Alternative Medicine. According to Ning and Ahkam, by 2007, approximately 40 percent of the Indonesian population used traditional medicine.

A variety of products were born and consumers steadfastly grew. Anna Dwi Kusuma, an entrepreneur from Batang, is one of the users that is satisfied with the herbal treatment she has taken to treat obesity and several diseases. "It's because I experience changes for the better, and I feel more comfortable using herbal medicine," she said. Herbal medicine users even include celebrities and high-ranking officials. Musician Katon Bagaskara, for example, chose traditional Javanese medicine to treat his wounds from falling on stage during a concert. He was satisfied because the results were faster and safer.

"Many people turn to herbal medicine not because it is safer than modern medical treatment that has been through strict scientific principles, but rather because the mindset and culture of Indonesians are still traditional and often believe more in custom or experience," says health practitioner Dr. Wibisono.

"The drawback is that most herbs have not been subjected to clinical trials, but only to hereditary experience, so they cannot be accounted empirically and medically, and may even contain unknown side effects."

In addition, just like in the modern medical world, herbal medicine is not spared from dirty hands that produce drugs with synthetic chemicals without mentioning it on the label. This caused the Indonesian Food and Drug Authority or BPOM to regularly conduct jamu raids in several regions.

Just like modern medicines, herbal medicines must meet safe criteria according to established requirements, and their efficacy must be proven based on clinical trials and meet quality standards. "Herbal medicines should not be used for serious diseases whose diagnosis can only be established by a doctor. Herbal medicine can be used when there is no rational medicine that can cure," wrote Jusuf Hanafiah, a doctor and professor at the Faculty of Medicine, University of North Sumatra, in Etika Kedokteran dan Hukum Kesehatan Edisi 4 (Medical Ethics and Health Law, 4th Edition).

The journey of herbal medicine continues until today alongside the modern medical treatment, each with their own pluses and minuses.