wiki_2_lagundi.jpgWiki 2: Life Cycle of a Product



As traced in the historical development of traditional and alternative healing technologies worldwide, herbalism is the oldest form of medicine both in the East and West. All ancient civilizations, especially the Chinese, Indian and Egyptian, had herbal medicine as an integral part in their medical systems. In many traditions, like that of the Native American and Filipino, this practice is centered upon the village healer or shaman. The Philippines’ albularyo (from the Spanish word ‘herbolario’ for herbalist) is especially versed in the use of medicinal herbs.[1] Now in the field of traditional and alternative healing, herbal medicine has maintained its role and from it, comes the most prominent of TAH products.

Like every product that comes out of any scientific knowledge or technological development, herbal medicine also has a life cycle. There is a production flow even in the centuries-old traditions of preparing herbs, either by mixing, crushing or boiling, and then administering to the patient. As discussed in Wiki 1, herbal medicine has been re-integrated to health systems that previously shunned these products as "quack" or part of folklore. With herbal formulas in modern medicine, we can now have more scientific resources and information to study life cycles of herbal medicine.

Wiki 2 intends to trace the life cycle of a herbal medicinal product to help us understand the interconnections and interactions of different fields of science and technology necessary to come up with such product. It will identify the processes involved in the six stages of the production of a specific herbal medicine, from design to raw materials acquisition, to manufacturing and distribution, and to consumption and disposal.

The Product: Lagundi

Lagundi.jpg


The revival of herbal medicine amidst the people’s dependence on synthetic pharmaceuticals came about in the Philippines in the early 90’s when its Department of Health and the Senate Committee in Health and Demography led by a Doctor of Medicine and former DOH Secretary, Sen. Juan Flavier, p ublished a brochure listing 10 medicinal plants (“Sampung Halamang Gamot”).[2] Very prominent and commonly known in this list is Lagundi, and recently it has been developed and produced commercially as a competing cough and asthma medication.

Lagundi, scientific name Vitex negundo, is one of the 10 herbal medicinal plants that have been clinically proven safe and effective by studies of the Philippine Department of Health and private research bodies. It is endorsed by the DOH and included in the Philippine National Drug Formulary.[3]

Lagundi is a shrub that grows up to 8 m tall, with usually 5 narrowly elliptical leaflets, rarely with 3 leaves only. Its bark surface rarely rough, peeling off in papery flakes, and pale reddish-brown. Its fruits are spherical to egg-shaped, 3-6mm, long, purple or black when mature. Lagundi shrubs are found in humid places along watercourses, in waste places and mixed open forests. It is found in Eastern Africa and Madagascar to Iran, Afghanistan, Pakistan, India, Sri Lanka, Burma (Myanmar), Indo-China, China, Japan, Taiwan, Thailand, throughout the Malesian region (including the Philippines), east to the Palau Islands, the Caroline Islands and the Mariana Islands. It is also widely cultivated in Europe, Asia, North America and the West Indies.[4] In folkloric traditions, a decoction of Lagundi is used for fever, headache, toothache, cough and asthma. A decoction is made by boiling parts of the plant and taken orally. [5]

Today, Lagundi is available in tablet/capsule and bottled syrup forms in the Philippines as commercially produced by government agencies like the Department of Health and Department of Science and Technology, and private pharmaceutical companies like Pascual Laboratories (for the highly competitive brand Ascof) and Trevenodd Corporation (for the newcomer Plemex).

For this wiki, Team Maramba aims to study the life cycle of commercial lagundi medications (in syrup and tablet forms). This wiki will discuss how and what for are they designed, what raw materials are needed for their production and how are they acquired, how are they being manufactured and distributed commercially, how are they being consumed and disposed.


Design.jpg1. Design


Lagundi is designed primarily as a safer and cheaper alternative to over-the-counter (OTC) cough and asthma medicine based on antitussives or cough suppresants, such as codeine and dextromethorphan (DXM). Therefore, the life cycle common to all Lagundi products anchor on its naturally originating extracts or active ingredients, organic sources and/or processes not involving the use of manufactured chemicals. Meanwhile, to make the products competitive in the OTC market and convenient for consumption, Lagundi products are also designed with some of the same modern pharmaceutical technologies that make their OTC counterparts like tableting and packaging.

1.1 As an all-natural, safer and cheaper alternative

As herbal medicine, Lagundi products contain as active ingredients plant materials. It does not contain plant materials combined with chemically-defined substances including chemically-defined, isolated constituents of plants. As a natural product, its ingredients grow spontaneously in nature and it does not use additives, preservatives, artificial colors and flavors, or manufactured chemicals of any sort after harvest.[6] Based on these definitions set by the Traditional and Alternative Medicine Act (TAMA) of 1997, Lagundi is a natural product and herbal medicine. The label "100% natural" is therefore used as a major design strategy to brand any Lagundi product.

Ascof, the leading commercial Lagundi product in the Philippines, is marketed as "made from 100% Lagundi leaves which were nurtured organically in a quality-certified farm untainted by synthetic chemical fertilizers and pesticides".[7] And since the active ingredients of this medicine are abundant in the country, it is also marketed as a cheaper remedy for cough and asthma, marketed as "almost 50% cheaper than leading chemical cough brands".[8]

This is to compete with common over-the-counter colds and cough medicine, the active ingredients of which are chemicals repeatedly found to cause side effects such as as development of hypertension, drug dependence, irregular heartbeat and confusion. Mayo Clinic, a medical research organization, said in an online statement that "most OTC cough medicines contain a mixture of decongestant, antihistamine, pain reliever, cough suppressant or a combination of these drugs. This combination is meant to treat many symptoms at once but all of them have potential side effects." [9] Dextromethorphan (DXM), a cough suppresant drug used in brands like Robitussin and Vicks 44 for example, is known to cause nausea, drowsiness, dizziness, shallow respiration, disorientation, toxic psychosis, among many other side effects. Recreational use can cause psychological addiction as DXM can be a dissociative hallucinogen, impairing judgment, memory, language and other mental performances.[10]

With growing awareness on the hazards of OTC cough medicines, Lagundi products become more and more popular as a safe alternative. This leverage of being "all-natural" (without the side effects of chemically-defined OTC medicines) can be seen in almost all marketing or campaign materials for Lagundi products, such as the following TV commercial for the brand Ascof, the first licensed herbal medicine in the Philippines.[11]

(Video here)

1.2 As tablet or syrup to be competitive and convenient

Based on folklore or traditional practices, the leaves of the Lagundi plant are boiled and taken orally (decoctions). So to make Lagundi commercially available, competitive and convenient to use, a different approach in preparing this herbal medicine had to be designed, but maintaining Lagundi leaf extracts as the active ingredient. This also required manufacturers to produce, package and distribute Lagundi in syrup or tablet forms, to compete with the herbal medicine's OTC counterparts. This is best shown in the following TV commercial for the brand Plemex, where it is said that "you don't have to boil Lagundi anymore".

(Video here)

The design process for Lagundi as herbal medicine involves centuries-old folklore; it dates back to the albularyos boiling Lagundi leaves and passing down this practice from generation to generation. Chemistry is at work in the process of decoction (a method of extraction by boiling of plant material)[12] and this technology evolved as it was practiced in folk societies. Now with modern means and different mindsets on medical practices, the design process involves packaging Lagundi in tablet forms or producing syrup. This will then need pharmaceutical technologies like that used in modern medicine, such as tablet compression tooling and techniques in achieving the right viscosity in syrups, and also as importantly, packaging technologies like the right materials (foil for tablets or bottles for syrup) for effective storage and long shelf life. Tablets, for example, need to be strong enough to resist the stresses of packaging, shipping and handling, and to test this would combine simple failure and erosion tests and more sophisticated engineering tests. All these considerations are addressed during the design of the formulation and manufacturing process in the research and development phase, of any medicine.[13]

Whether herbal or not, it will also require scientific knowledge to make oral medicine easy to swallow and as with pleasant taste as possible. Competition in the herbal medicinal market and as well as with mainstream OTC cough medicines oblige Lagundi manufacturers to improve consumer experience by making their products look, smell and taste as good as their counterparts, if not better, without compromising their main design approach of being an "all-natural", safe, cheap and effective alternative.

It remains to be studied further, however, as to what specific design approaches employed by different brands are most effective, and if these designs meet the actual life cycle results of each specific Lagundi product. In the Philippine market today, major Lagundi brands include that of the government - the Department of Health's Philippine Institute of Traditional and Alternative Health Care (DOH-PITAHC) - and that of private pharmaceutical companies such as Pascual Laboratories' Ascof and Trevenodd Corporation's Plemex.


Extraction.jpg2. Extraction


What are the raw materials needed for the making of Lagundi products, where are they from and how are they acquired? We take a look in this stage of Lagundi products' life cycles, identifying the steps of extraction or raw materials acquisition, and the sciences and technologies that work together in the processes involved.

The lagundi tablet as packaged for consumers is composed of the following components:
lagundibox.jpg
Lagundi tablet components

  1. Compressed lagundi leaves - the main ingredient
  2. Aluminium foil - where the medicine tablets are stored for protection and longer shelf life
  3. Packaging box - where the pack of tablets inside the aluminum foils are placed for better handling and better storage management
  4. Paper - where the medical literature is written and included in the medicine package

Each of these components have been extracted from different sources.

2.1 Lagundi leaves

The lagundi shrub is the main source of the lagundi leaves. Although it can grow anywhere in the Philippines, several herbal plantation farms have commercially grown Lagundi all over the Philippines.

From the lagundi plantation farms, the following process follows: [14]
  1. Harvesting - usually done during the flowering stage.
  2. Washing of raw materials - dust and other dirt particles are washed with clear running water.
  3. Drying - using a leaf dryer with regulated heat of 60 degrees centigrade, the lagundi leaves are spread of the drying beds and left to dry.
  4. Garbling - the lagundi leaves are separated by hand from other parts of the plants as well as other particles and contaminants.
  5. Delivery to the milling site for processing - the lagundi leaves are then put into boxes and delivered to milling sites for processing

2.2 Aluminium foils

The aluminium foil used for packaging the lagundi tablet is based on the following processes and technologies:

Process
Technology
1.
Bauxite ore extraction
Mining technology
2.
Alumina production
Bayer chemical process in refineries
3.
Primary Aluminium production
Electrolysis
4.
Semi-fabrication
Manufacturing
5.
Commercial alumimium product
Manufacturing

The process of extraction of alumimium foils is further discussed in this sub-page: Foil Pack

2.3 Packaging box and paper

The packaging boxes and paper are processed products from trees. The process of producing paper boxes and paper is based on the following processes and technologies:


Process
Technologies
1.
Cutting of trees
Timber technology
2.
Wood chipping
Mechanical pulping
3.
Pulp production
Chemical pulping
4.
Crude Paper sheets
Paper milling
5.
Cutting into paper sheets
Paper cutting

The process of paper and packaging box extraction/production is further discussed in this sub-page: Packaging Box and Paper


production.jpg3. Production


After the Lagundi leaves are produced in farms, they are transferred to the laboratories and factories to be tested for bacteria and to be made into tablets and syrups. The process presented is based on the interview with Pascual Laboratories.

3.1 Processing

The Lagundi leaves are then measured for nutrients and and bacteria in order to test if it contains the required amount of chemical markers and metabolites. This measurement is a key in achieving the "clinically proven" certification.

The leaves are then sanitized with ozone water and not with tap water which contains chlorine. Washing the leaves with ozone water also maintains it to be "all natural" so that it would be untouched by synthetic chemicals like chlorine.

Water used in this process flows to a man-made river which is filled with granite to filter the water; it is then reused to water plants.

After the measuring and sanitation, the leaves are then processed to be made into tablets or syrups. The processes are as follows:

Tablet
Remarks
Syrup
Remarks

The leaves are dried using a solar tunnel/ Flat Bed Drier.
Automated with minimal human intervention but closely supervised.
The Lagundi Leaves are placed into an extraction device which extracts the juice from the leaves.
Automated with minimal human intervention but closely supervised.
Milled or grounded into powder form

By Product: The drained leaves go back to the form and transformed as organic compost.
Manual Labor
Mixed with starch in order to create the mixture for tablet conversion

The extracted juice is automatically transferred into a concentrator machine in order to increase the density of the extract.
Automated with minimal human intervention but closely supervised.
Mixture is transferred to a tabletting machine.
Automated
The Extract is transferred to the pharmaceutical standard clean room where the extract is combined with Ultra Pure Water and Sugar Syrup in order to produce the finished syrup.
Automated with minimal human intervention but closely supervised.
Tablets are tested for weight, density / “hardness” and disintegration time.
Automated
Still in the clean room, the, the syrup is tested (for consistency, PH and bacteria) before the extract is transferred to and for bottling.

Rejected tablets are pulverized and returned to the tablet machine
Automated with human intervention



3.2 Packaging

The Lagundi Capsule is then packed into foil containers, while the syrup is placed in medicine bottles. Both products are packaged in a box with instructions.

distribution.jpg4. Distribution


Distribution is the process of transferring the products to locations where consumers can easily access them.

Based on our studies, pharmaceutical companies in the Philippines normally engage distribution companies in order to simplify logistics, inventory and sales management. In our studies, we found out that Pascual Laboratories, manufacturer of Ascof Lagundi has adopted the same model by contracting Zuellig Pharma Corporation but additionally formed another company (Altermed) that provide close monitoring of sales and inventory at the pharmacy level.


4.1 Marketing Strategy

Altermed, handles the sales and marketing of Lagundi products. They use endorsers, radio and TV commercial and billboards to promote their product. Their message is all natural cough and asthma medicine which is clinically proven.

The Philippine Council for Health Research and Development of the Department of Science and Technology (DOST-PCHRD) had been openly advocating Lagundi products (Lagundi tablet and syrup) for years now. In Sept 2008, the products were featured along with 7 other health technologies during the launching of the project "One Stop Information Shop of Technologies (OSIST) in the Philippines. The OSIST is compendium of mature technologies available in the internet. [15]

4.2 Ordering and Allocation

The inventory allocation for pharmacies is normally based on the population where the pharmacies are located. Pharmacies in densely populated areas require more management as turn-around is faster. Inventory and sales are managed by the distributor by assigning representatives (agents) on areas where pharmacies are located. The agents routinely visit the pharmacies in order to manage sales and inventories. The frequency of visits may vary depending on the area; a pharmacy in a densely populated area will require once a week visitation while others may only require one visit per month.

Replenishments or re-ordering are either initiated by the pharmacy manager by calling the attention of the agent / distributor or upon visitation by the agent.


In the case of Pascual Laboratories, they needed a closer monitoring of their product's turn-over thus formed Altermed. Altermed also deploys such agents in order to monitor and manage sales and inventories at the site,

4.3 Delivery

Principal to Distributor (Alermed to Zuellig): The distributor orders from the principal and normally the principal delivers the goods directly to the distributor.

Distributor to pharmacies: The distributor then ships the stocks according to allocation or order from the owners of the pharmacies. Stocks are sealed in boxes in order to keep the products safe from contamination and damage.



4.3.1 Expiration (Pull-out)

The employees in pharmacies diligently check their merchandise in order to remove expiring products. They prioritize this safety precaution in order to avoid contaminating medicine that are near the expired one. The agents from the distributors also contribute to this activity. Disposal procedures also vary. Some pharmacies throw away expired medicine, in the case of Ascof Lagundi, the distributor normally pulls-out the expired products, ships them back to Altermed for proper recycling.

4.3.2 Buyers

People who usually buy lagundi tablets are those who have families (for use and maintenance), small clinics (for their own supplies) and owners of sari-sari stores that sell medicines.

4.4 IT Technologies that help improve Distribution efficiency

In manufacturing and distribution companies, supply chain management is critical. Manufacturers and distributors require reliable information systems in order to distribute the proper information to key team members, Enterprise Resource Planning systems (ERP) such as SAP™ and Microsoft® Dynamics NAV™ , enable manufacturers and distributors to gain access to such critical information from a central source.

However, information that needs to be transmitted outside the company's premises require special computers such as laptops and PDAs including mobile computing connectivity. Such special devices which can be connected to the Internet allow users to transmit data on the fly, where ever they might be as long as an a signal can be used to connect to the internet . Connecting to the Internet enables data to be transmitted via a company website (a simple form of record updating) or via Virtual Private Network (a more sophisticated technology, allowing a user to be virtually connected to the company's local area network (LAN) including it's resources such as ERP systems, printers, chat facilities and even local phones). With such timely record-updates management and their teams respond promptly to business requirements related to distribution (at the very least).

Global Positioning Systems (GPS) are also used to monitor delivery vehicles. With GPS, management including agents can always check where the vehicles are and why are they there (traffic/breakdown or hijacked) thus be able to inform all concerned. Security and customer service are improved by using the information which are gained through GPS technology.

Mobile phones and C.B. radios also provide prompt and inexpensive means of communication.thus help in coordination when distributing products


consumption.jpg5. Consumption


5.1 Useful Life of Lagundi


Like any herbal plant, lagundi is at best condition when dried especially when the moisture content is at 10 % because it makes the medicinal components concentrated. Moreover, the dryer the plants the more effective they are. Drying the plant also gives a more palatable taste. Some people fries the leaves to prevent the formation of molds. It also makes the crushing of the leaves easily in making lagundi tea.
To ensure good quality of outputs, healthy leaves should be collected 500 m away from polluted area. Collect the plant on three consecutive sunny days from 7:00 AM to 10:00 AM. Temperature, humidity, light and manner of handling during harvests also affect the active constituent of the plant. Leaves are best collected when the plant is about to bloom or before the flowers open; and spare some leaves otherwise the plant will die.
Lagundi’s volatile oil content makes it delicate with direct light so it is usually placed in a brown bottle. Other than natural bruise, mold formation is the primary indication that the medical components of lagundi are destroyed.
[16]

5.2 Indications and Usage


The plant’s leaves and seeds were used by Filipinos to disinfect wounds and in cleansing ulcers. The leaves are also used in aromatic baths to prevent insect bites. Alternatively, the seeds are boiled in water and eaten, or the water is drunk, to prevent the spreading of toxin from bites. Other accounts proved that the fresh leaves when heated over a fire, is effective for sprained limbs, contusions and leech bites.

In India, the oil from seeds is rubbed onto the sinuses and to scrofulous sores of the neck. There was a noteworthy account of the cure with this oil of an old and deep gangrenous wound in the arm of a patient. This patient was given up by allopathic doctors after three months of medical treatment, cure having been considered hopeless without amputation of the arm.

The roots of lagundi are also taking part in the wide fame of the plant. A tincture of the root-bark is recommended in cases of rheumatism. Moreover, the powdered root is prescribed for hemorrhoids as a demulcent, and also for dysentery.

Decoction is the most convenient and familiar way of preparing any herbal medicine. No wonder that a compilation on herbals and food supplements prepared by Dr. Jaime z. Galvez Tan proposed a dosage pattern from boiled lagundi leaves.

He advised that for fever and toothaches, one needs to boil 6 table spoons of chopped leaves in 2 glasses of water for 15 minutes; strain and cool. Divide the decoction in 3 parts and take one part every 3-4 hours. For asthma and cough, take ¼ of the decoction three times a day. For aromatic bath or sponge bathing: boil 4 handfuls of leaves in a pot of water for 5 minutes; use the lukewarm decoction for sponge bathing.


Having to do the traditional preparation of lagundi three times a day for the treatment to be effective is far too troublesome for a person living in this day and age. With the help of technology and pharamaceutical companies, Lagundi is now available in syrup and tablet form.

Lagundi is one of the ten herbal medicines endorsed by the Philippine Department of Health as an effective herbal medicine with proven therapeutic value .It has been clinically tested to be effective in the treatment of colds, flu, bronchial asthma, chronic bronchitis, and pharyngitis.Studies have shown that Lagundi can prevent the body's production of leukotrienes, which are released during an asthma attack. Lagundi contains Chrysoplenol D, a substance with anti-histamine and muscle relaxant properties[17] Histamine is defined as a protein involved in many allergic reactions. Allergies are caused by an immune response to a normally innocuous substance (i.e. pollen, dust) that comes in contact with lymphocytes specific for that substance, or antigen.It contributes to an inflammatory response and it causes constriction of smooth muscle[18] Asthma attacks happen due to allergic reactions. Medicines with anti-histamine properties such as Lagundi can help ease and prevent these attacks.

5.3 Dosage and Administration


As previously mentioned, Lagundi is available in syrup and tablet form. Ascof (300mg) and Ascof Forte (600mg) which is manufactured by Pascual Laboratories are available in both forms. They are taken orally with or without food. It is safe to take before or after meals.

MIMS Philippines indicates that Lagundi medicines can be a relief of cough caused common colds & flu. They are treatment of bronchospasm in acute bronchial asthma, chronic bronchitis & other bronchopulmonary disorders.

Some reported adverse drug reactions for tablets are itch, nausea, vomiting and diarrhea without a predominating complaint. No reported complaints for syrups during clinical trials.

Dosage:
Tab/Forte tab Adult 300-600 mg tid-qid. Childn 7-12 yr 300 mg tid-qid. Syr Adult 300-600 mg (5-10 mL) 1-2 tsp tid-qid. Childn 15 mg/kg/dose tid, >40 kg 2 tsp tid, 6-12 yr (20-40 kg) 1½ tsp tid, 4-6 yr (15.5-20 kg) 1 tsp tid, 2-4 yr (10-15.5 kg) ½ tsp tid.[19]

5.4 Product Consumption Survey and Reviews


disposal.jpg6. Disposal


According to Engr. Jun Saret Jr., Vice President of MFC/SCM/NBD/R&D/Plant and Herbal, there are different ways on disposing different kinds of expired medicine. The disposal of expired syrups is different from the disposal of expired tablets.

" ...are brought to LAC for natural composting and fertilization. Expired tablets are grounded and pounded and sold to cement suppliers– yes they are in the hollow blocks now. " [20]

​He also said that medicine bottles and foils are recycled and segregated by companies which these wastes are sold.

Lagundi products have a shorter life cycle compared to materials for long-term use (like electronics, for example) and the disposal rate of its components are higher. Lagundi medicine, or any over-the-counter drugs for that matter, are bought and consumed within a relatively short period of time.. The products' packaging are therefore more quickly disposed; meaning, the more lagundi medicine you buy, the more packaging materials you throw away after using. And since lagundi is quickly consumed, its pace of being disposed becomes faster as well.

6.2 Lagundi component

The actual lagundi component upon consumption becomes a material for disposal as well. However, since lagundi is a product of traditional and alternative medicine, it is often described as "natural" and its consumption byproducts inside the user's body supposedly do not contain harmful chemicals like toxins. This as a result, makes lagundi "safe waste" to the user's physical health and eventually to the environment through the body's excretions.

6.3 The packaging materials



Analysis, Conclusions and Recommendations








references.jpg

References


  1. ^ Stuart, G. U. "Philippine Alternative Medicine". http://stuartexchange.com/altmed.html. Retrieved 01-28-2010.
  2. ^ "Gabay sa Sampung Halamang Gamot". Senate Committee on Health and Demography. Republic of the Philippines. 1993, p 20, Philippines.
  3. ^ Philippine National Drug Formulary (PNDF) Vol. 1, 5th Edition. 2000.
  4. ^ PROSEA Herbal Techno-Catalog. PROSEA Philippines – Philippine Council for Agriculture, Forestry and Natural Resources Research and Development (PCCARD). http://www.pcarrd.dost.gov.ph/prosea/proseaherbal/lagundi_doc.htm. Retrieved 01-28-2010.
  5. ^ Philippine Herbal Medicine. http://www.philippineherbalmedicine.org/lagundi.htm. Retrieved 01-28-2010.
  6. ^ Article 2, Section 4. Definitions. Republic Act No. 8243. Republic of the Philippines. Enacted into law 12-09-1997.
  7. ^ "Ascof Lagundi". Products online catalog, Pascual Laboratories. http://www.pascuallab.com/product.php?id=547. Retrieved 01-30-2010.
  8. ^ "Ascof Forte Metro" TV Commercial. Well Advertising. http://www.youtube.com/watch?v=c07ZWC81Zag. Retrieved from YouTube 01-30-2010.
  9. ^ "Side effects of chemical cough drugs bared". The Philippine Star, 01-24-2008. Archived at the Philippine Council for Health Research and Development (PCHRD) Library. http://www.pchrd.dost.gov.ph/library/index.php/health-news/590/835. Retrieved 01-28-2010.
  10. ^ Dextromethorphan. "Drugs and Human Performance Fact Sheets". National Highway Traffic Safety Administration, U.S. Department of Transportation. http://www.nhtsa.dot.gov/PEOPLE/injury/research/job185drugs/dextromethorphan.htm. Retrieved 01-28-2010.
  11. ^ "Ascof Lagundi: Heal ye, heal ye". The Philippine Star. 11-24-2009. http://www.philstar.com/Article.aspx?articleId=526095&publicationSubCategoryId=80. Retrieved 01-28-2010.
  12. ^ "Decoction". Biology Online: Answers to all your biology questions." http://www.biology-online.org/dictionary/Decoction. Retrieved 01-28-2010.
  13. ^ Kibbe, A.H., ed. Handbook of Pharmaceutical Excipients. 3rd Edition ed. 2000, American Pharmaceutical Association & Pharmaceutical Press: Washington, DC & London, UK.
  14. ^ PITAHC. (n.d.) Herbal Processing Plants. Retrieved on January 30, 2010 from
    http://www2.doh.gov.ph/pitahc/Herbal_Processing_Plants.html
  15. ^ Julie Callope. "PCHRD To Showcase Health Technologies at OSIST Launching"
    Saturday, 27 September 2008
  16. ^ http://prakx.wordpress.com/
  17. ^ www.philippineherbalmedicine.org/lagundi.htm
  18. ^ http://www.bio.davidson.edu/courses/Immunology/Students/spring2000/lamar/mfirp.htm
    2000, Department of Biology, Davidson College, Davidson, NC, USA
  19. ^ MIMS Philippines. http://www.mims.com/Page.aspx?menuid=mng&name=Ascof+Forte+syr&h=ascof&CTRY=PH&searchstring=ascof
  20. ^ Saret, Jun Jr.Personal Interview. 4 February 2010..