Sidik
For many years locally produced jamu as well as manufactured jamu
have played an important role in health care. This article presents an overview of the current status of this
indigenous medicine and its role in the national development of Indonesia. It is argued that scientists must
pay more attention to traditional methods of preparing and using jamu.
Jamu is the Indonesian term for indigenous medicine usually prepared from herbal materials. Even where modern medicine is readily available, a large portion of the population still depends heavily on jamu. It is estimated that 70-80% of Indonesian people traditionally maintain their health by regularly drinking jamu (Afdhal, 1991; Soedibyo, 1990).
There are three sources of jamu:
The role of jamu in national development
Jamu has two main roles in national development: in national health care and in the economy
of rural areas. Ninety percent or more of the raw materials used in modern Indonesian medicines, and
virtually all of their active ingredients, are still imported. The costs of importing, manufacturing and
distributing such medicines to over 180 million people spread widely over many islands is a drain on the
country's foreign exchange reserves. The government therefore supports the use of jamu in
primary health care, as long as there is no evidence of toxicity or other dangerous side effects. Another
advantage is that jamu is produced mainly using traditional techniques, which are non-mechanized or only
semi-mechanized. This creates many job opportunities.
With the expansion of the National Programme of Transmigration, the Department of Health has been encouraging new settlers to plant medicinal plants for family use in their new gardens, the so-called TOGA. TOGA is an abbreviation of Taman Obat Keluarga, which means family medicinal plants. In transmigration areas, development of TOGA gardens offers the following advantages: better health care, reduction of community diseases, improvement of nutrition, conservation of nature, replanting of medicinal plants, distribution of profit and growth, and development of cooperatives (Bambang Sutrisno, 1981).
It is an old tradition of the Javanese people that as part of the wedding ceremony, the mother of the bride presents to the newly married couple a box containing several kinds of seeds, rhizomes, and dried cuttings of traditional medicinal plants and spices. These are to be used on the first day of marriage and, what is more important, they are to be planted in the garden of the couple's new home. This is interpreted as a mother's last symbolic effort to provide a healthy life for her daughter.
The present status of traditional medicine
In Indonesia, jamu is used purely for self-medication. Indonesian doctors will use
jamu only if the bioactive compounds have been identified and quantified, and only if full
details are available on possible toxicity, side effects and complications. (This is known as
phytomedicine.) Such concern is not shown elsewhere in Asia, where doctors believe that if such
traditional medicines have been used by millions of people for decades with no reports of fatalities, then
it should be safe to prescribe them.
At present, the industrial manufacture of jamu is strictly controlled, and jamu are subject to normal drug registration. However, scientists still have surprisingly little understanding of the composition of the active ingredients in most jamu preparations. One of the prominent figures in jamu and cosmetics in Jakarta said: 'In principle, traditional healing is the effort to maintain the equilibrium between man and the laws of nature. The men should therefore be treated as a whole, and never partially (only their teeth, eyes, hearts, etc.), as is done by our medical doctors. It is said that jamu has multiple effects. This is because the aim of composing jamu is not merely to combat a particular disease but also to restore equilibrium through the human body's own resistance.' (Soeparto, 1980)
Old Balinese people believe that illness and ill feelings are caused by disturbances in the equilibrium between the three main forces of nature (including the human body), the so-called Tri dhatu. These three forces are related to the dogma Ang, Ung and Mang--or Brahma, Wisnu and Iswara. The Tri dhatu are also elements of the macro-micro cosmos (Mantra, 1964). The Javanese believe in four main forces as elements of the macro- micro cosmos. Indeed, supra-naturalism is still a strong principle underlying the preparation of jamu. Several people preparing jamu (either industrially, as a home industry, or individually from fresh ingredients) confessed that before they start to work they always pray to God and ask for their ancestors' blessing. They believe very strongly that without prayer, the prepared jamu will be inactive.
Also interesting is the way in which certain compounds are added to jamu for symbolic reasons. For example, to the medicines of pregnant women are added charcoaled mouse nests and powdered egg shells from newly-hatched healthy chickens. Pharmacologically, the mother is receiving carbon and calcium. Carbon, as an adsorbent, may reduce the toxins circulating in the body, and calcium is beneficial to both mother and foetus. Traditional healers believed that by using the mouse nests the birth of the baby would be as easy as that of the mouse. The egg shells symbolize the healthy newly- hatched chicken, and the hope is that the baby will be equally healthy (Soeparto, 1980).
In general, the quantities of the various compounds and components that are used in traditional medicine are measured very crudely: in terms of spoons, vessels, cups or even by the number of seeds or leaves. It is said that exact measurements are not necessary because jamu is rather like cooking, an "art" that puts emphasis on judging what is likely to taste good.
Suggestions for further research and development
There have been scientific disputes between scientists and traditionalists on the subject of
jamu. For many years now, scientists have questioned the value and effectiveness of
jamu. There are those who believe that the use of jamu falls more within the
realm of homeopathy than within the realm of accepted Western medical practices. There is also
considerable disagreement regarding the extent to which the production and preparation of
jamu should be modernized. One of the main problems is that much of the preparation is
closely interwoven with traditional lifestyles. Furthermore, traditionalists are very resistant to having
methods imposed on them for the proper handling and selection of materials, and for powdering,
measuring, extracting and filtering. Finally, there are inevitable disputes between scientists and
traditionalists when it comes to interpreting pharmacological activity. These disagreements are very
difficult to resolve.
In recent years, dosages have changed, especially of jamu manufactured by industry. For example, powders which previously required extraction by hot or boiling water are now being presented in the form of tablets, pills, capsules and dipped tea. In these cases, where the active components are taken orally, acidic gastric fluids extract the active components whereas in the past this was done with boiling water. The extent to which these two different forms of administration produce similar pharmacological results has still to be determined.
Scientists are devoting an increasing amount of time to the search for new bioactive compounds and new medicines. Two lines of investigation are being followed. In the chemical approach, experimentation proceeds step-by-step from extraction, separation, isolation and purification, through to structural elucidation, theoretical deduction of bioactivity, and eventually pharmacological testing. In the second type of investigation, bioactive screening of the crude and fractioned extracts is followed by the chemical approach, which involves only the active fraction. For Indonesia, pharmacological and toxicological screenings of jamu should be the first priority of jamu research and development. However, there are two main constraints. First, there are many problems associated with obtaining standard forms for research purposes; and second, it is difficult to know what to market when in the past jamu have been so variable and apparently so successful.
Conclusion
There is no doubt that jamu merit more attention from the scientific community, and that they
play a significant role in national development, especially in the areas of national health care and rural
economics. They also present a real challenge to scientists who still do not understand all aspects of the
pharmacological activities. Finally, as so many of the traditional medicines are influenced by, and related
to, traditional lifestyles and beliefs, these lifestyles should be maintained where possible so that
jamu can be investigated as thoroughly as possible.
Prof. Sidik
Laboratory of Pharmacognosy
Faculty of science
Padjadjaran University
P.O. Box 6571
Bandung 40114 A
Indonesia
References
Afdhal, A.F. and R.L. Welsch (1991) 'The rise of the modern jamu', pp. 149-172 in Van Der
Geest, S. and S.R. White (eds) The context of medicines in developing countries. Amsterdam:
Het Spinhuis.
Bambang Sutrisno, R. (1981) 'Taman Obat Keluarga (TOGA).' Paper presented at Penyuluhan Obat Traditisional, Bandung, Indonesia.
Mantra, S. (1964) 'Later belakang Asuadha Bali Kuno dalam hubungan dengan pandangan hidup.' Paper presented at Seminar Penggalian Smber Alam Indonesia untuk Farmasi, Yogyakarta, Indonesia.
Riswan, S. (1990) 'The traditional medicine of plants in Indonesia.' Paper presented at the 4th International Symposium of Chinese Drugs, Japan.
Soedibyo, M. (1990) 'Javanese traditional medicine.' Paper presented at the International Congress on Traditional Medicine and Medicinal Plants, Denpasar, Bali, Indonesia.
Soeparto, S. (1980) 'Meracik jamu.' Paper presented at Consultative meeting Pemanfaatan Tanaman Obat, Direktorat Jenderal Pengawasan Obat dan Makanan Dept. Kesehatan RI, Jakarta, Indonesia.
On 25 September 1993, the Indonesian Foundation for Promotion of Natural Resource Medicines awarded Professor Sidik the Phyto Medica Award. Professor Sidik obtained this award for his important pioneering research on jamu, particularly the combination of Curcuma Xanthorriza, Curcuma Longa and Silmymarin for the treatment of liver disease.
Professor Sidik, a graduate of Institut Teknologi Bandung (ITB), obtained his PhD in the field of
pharmacognosy at Universitas Padjadjaran in Bandung. He has written almost one hundred scientific
articles and four books on indigenous medical knowledge and practices in Indonesia.
He will continue his research on the biologically active compounds in indigenous plants. His research
concerning the isolation of such compounds from Curcuma Xanthorriza, Curcuma
Longa and Silmymarin has recently led to the subsequent use of specific elements in
the phytomedical Indonesian/German co-production of an officially registered medicine for liver diseases
called Cursil. In this way, indigenous medical knowledge about the therapeutic potential of
local plant species has been integrated into the national health care delivery system of Indonesia.