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Cuban herbal and medical insights.

Declarations

There are no source(s) of support in the form of grants, equipment, drugs or all of these.

Acknowledgements

Thanks to Dr Sue Evans who generously shared her knowledge on this topic with me. Thanks to Nicole Quaife, who helped to make the contact possible.

Introduction

I have been fortunate enough to travel to Cuba four times in the last three years. I am married to a Cuban man and, as a consequence, have inherited a community of family and friends who have opened my eyes and my heart in many wonderful ways. As a naturopath, I like to explore the health and complementary medicine culture whenever I travel to another country. The combination of my curiosity and these inspiring people has given me an insight into some of the herbal medicine practices on the island, as well as a sweet reminder that the garden and the pantry are still excellent places to head to should an occasion call for a remedy.

The Cuban health care system is well known as a provider of free medical care for its people. Pharmaceutical medicines, however, are prohibitively expensive for many people (the average monthly salary of a government-employed citizen is equivalent to US$25), despite them developing more favour amongst Cubans. The alternatives, however, are in abundance and have not been abandoned by the community; quite the opposite, with the presence of the green pharmacy sitting alongside modern medicine on most pharmacy shelves.

Cuba is the largest island in the Caribbean and is inhabited by over 11 million people (1). Its climate is mild subtropical, with average temperatures ranging between 20 and 35[degrees] Celsius throughout the year; however, during winter it can reach lows of 10[degrees] in some regions (2). Cuba has a wet season (May to October) and a dry season (November to April), as well as a hurricane season between June and November (3).

I have spent the majority of my time in a city called Baracoa (population 81,000), located in the Guantanamo province in the eastern tip of the island (3,4). Baracoa is one of the oldest cities in Cuba, founded by Christopher Columbus in 1492 (3). It was the original capital city of the island nation (the honour was later bestowed on Havana in 1592 (5)). The geographical make up of this region is such that it boasts its own microclimate; the city is surrounded by mountain ranges and a river system that is ideal for agriculture such as cacao, which supersedes sugar as one is one of the most prominent Baracoan exports (6).

The average temperature in Baracoa sits between 28[degrees] and 30[degrees] Celsius, peaking between June and August (7). The annual rainfall in is approximately 1207 mm and the humidity in this region averages up to 80% (7). This unique climate helps to enhance a plethora of medicinal plants that are seemingly readily available. Walking down the street, native plants are abundant, including Moringa, (Moringa oleifera) famously exalted by Fidel Castro, who claimed that this plant contained every amino acid that the body needed, as well as providing digestive and sedative qualities (8). The leaves of the Moringa plant, indeed, contain iron, phosphorus, calcium, potassium, vitamin C, flavonoids, [beta]-carotene, vitamins A and D, as well as essential amino acids (9).

Baracoa was assaulted by Hurricane Matthew in October 2016 and, while most news articles in Australia focused on the effects on the Miami coast, the town is still picking up the pieces as I write. (Coconut trees can take up to eight years to grow and flower, before even producing any fruit. (10)) Since then, Hurricane Irma (September 2017) has had a devastating impact on Cuba; however, more so on surrounding islands. The spirit of the Cuban people is such that they help each other through these disasters, but also through everyday life. Community is not reserved for special occasions or catastrophes; it is the very foundation of this unique culture.

In previous visits, I have seen abundant herbal dispensaries and threadbare supplies of pharmaceutical medicines. On my most recent visit, there were more pharmaceuticals available; however, there were no antibiotics available to treat my husband for infectious diarrhoea and fever, contracted within days of arriving (Saccharomyces boulardii did not help). Friends, family and neighbours shared what they had, which ultimately led him back to the emergency section of the hospital for intravenous steroids due to a reaction to the antibiotics.

The green pharmacy is a travelling herbalist's delight. Not only because it is an assurance that herbal medicine is available in Cuba, should one require it; it is also a fascinating cultural insight. Walking into most pharmacies (I say most because I haven't seen them all and am assuming, based on discussions with my husband) there is a distinct line that separates the pharmaceuticals from the herbs. The pharmacists are trained in herbal medicine and give over the counter advice, as well as dispense accordingly. What are most intriguing are the posters that support and advocate the use of herbal medicine. The posters discuss the use of phytopharmaceuticals in treating respiratory, digestive and cardiovascular issues, as well as affectations of the skin, inflammation and anxiety. The scientific and traditional evidence behind the herbs are mentioned, as well as the caveat that everyone should speak with a doctor or pharmacist before using any herbs, particularly the young, elderly and pregnant women.

Table 1 is from one of the posters that has been translated to demonstrate the recommendations for herbal alternatives for conditions that might otherwise be treated with pharmaceuticals, which are also listed. As mentioned, the use of herbal medicine is still present within the community; however, with a greater presence of pharmaceuticals, the national health system is trying to reinvigorate the use of herbal medicine. This is to help keeps costs down for people, as well as maintain a viable alternative treatment.

We heal in green

Imefasma syrup is a commercial product that has been developed by the Health Department of Cuba, specifically for its bronchodilator and expectorant actions (11). One of the main ingredients of the syrup is Majagua, or Beach Hibiscus (Hibiscus tiliaceus L.). Beach Hibiscus comes from the Malvaceae family, is high in antioxidants and is reported to be used for bronchitis, coughs and fever (12).

Romerillo, or Chilean Little Rosemary (Baccharis linearis), is from the Asteraceae family and exhibits antimicrobial activity via the presence of constituents such as [gamma]-terpinene, limonene, terpinen-4-ol, [alpha]-cadinolol and [alpha]-cadinol (13).

Pino macho or Caribbean pine (Pinus caribaea), is from the Pinaceae family and has shown larvicidal activity due to its lignin concentration in the leaves (14).

Canadonga (Cassia grandis) is from the Leguminosae family and has shown potential antidiabetic, hypolipidaemic and hypocholesterolaemic activity in the stems (15).

Mangle Rojo, or Red Mangrove (Rhizophora mangle) is from the Rhizophoraceae family (16). The tannin-rich bark is thought to possess antioxidant properties; traditional use has been attributed to its astringent, antiseptic, antifungal and haemostatic properties (16).

Anamu, or Guinea hen weed (Petiveria alliacea) is from the Phytolaccaceae family (17,18). The roots and leaves are used for their antispasmodic, anti-inflammatory, anodyne and hypoglycaemic properties and can also be used topically for its antirheumatic effects (17). There is also report of the plant being used as an abortifacient, emmenogogue and depurative and administered in some countries as an infusion for patients with leukaemia and breast cancer (17).

Orange Jasmine, or Mock Orange (Murraya paniculata), is a tropical shrub from the Rutaceae family (19). It grows in the tropical and subtropical regions of the world, including Southeastern Asia, Cuba and northern Australia (19). This plant is commonly seen is Australia as an ornamental hedge; however, it is used in Indian and Malaysian cooking and in traditional medicine to treat a range of gastrointestinal ailments, blood stasis, oedema and headaches, while also being used as an anaesthetic, expectorant, detoxifier and anticonvulsant (19). The leaf and bark are reported to be astringent, anti-inflammatory, antinociceptive, antidiarrhoeal, antidiabetic and antiparasitic (19).

I thought I had perhaps won the in-law lottery when I discovered that my husband's family's garden was full of medicinal plants, amongst other reasons. A range of plants grow among the coconut, avocado, plantain, banana, Malanga (taro), guava, sapote (Mexican apple), guanabana (Soursop), Noni (Morinda citrifolia), custard apple, lemon, orange, guapen (native to Baracoa) and name (yam) plants and trees and live in reasonable harmony with chickens, two dogs, a cat, the occasional pig and, previously, goats. The garden tours were officiated by Dora, my husband's 101-year-old grandmother, as well as every member of each generation of the family; everyone is familiar with what is available in the garden. The garden itself contains a range of herbs, some of which we use. Peppermint (Mentha x piperita), Chamomile (Matricaria recutita) and Calendula (Calendula officinalis) are mainstays.

My husband has had ongoing problems with the ligament in his knee since before our visit to Cuba in 2016. I administered a range of nutritional and herbal supplements (I hear you: never treat friends and family) before and after our trip. His mother took over whilst we were in Cuba and applied Trebol (Eupatorium aromaatisans) by heating the leaf, covering his knee in lamb fat and wrapping it around the affected area. This plant is known in Cuba to help alleviate headaches, to help with the pain of rheumatism and toothaches, as well as for internal use to help with stomach ache (20).

His knee had not been too problematic until we climbed La Loma De La Cruz (The Hill of the Cross), a steep, 456-step climb to a spectacular lookout of the city of Holguin, with an illuminated cross, a restaurant and the best Wi-Fi reception in the city. Holguin is a four-hour drive from Baracoa. (Or seven hours, if I am driving or in the passenger seat, telling you to slow down on the sometimes gravel, often potholed country roads shared by trucks, cars, horse and carriage, motorbikes, bicycles, bicitaxis (a Cuban version of a rickshaw), slow-moving pedestrians and dogs, horses and goats that have not quite been trained to read traffic.) This climb is used by many locals for their daily workout and Facebook fix.

Upon our return to Baracoa, my husband mentioned the problem with his knee to a friend, who quickly took him to his neighbour. It was here that he was given a block of wood (about 5 kg), as well as a bag of pulverised wood chips. I told him that it would be impossible to bring the wood back to Australia, due to the strict quarantine laws (and no, we didn't try to sneak it in!). Back at home, he decocted with one part powder, two parts water and reduced the water down by half. He drained the water and added to it the same quantity of honey. When I asked the name of the tree, he told me and professed its amazing anti-inflammatory and vulnerary properties. As with many herbs that he knows, he asked me to investigate to see if the tree grows in Australia. My usual approach is to use the Spanish name to look for the Latin name and, subsequently, the English name, if it is not the same species that I am familiar with. I used this approach and discovered that Guaicum sanctum is readily available in this part of Cuba and is often used to make sculptures to sell to tourists, as well as for its medicinal properties.

During the last visit, I suffered from a nasty bout of gastro (I am not sure there is such a thing as a pleasant bout of gastro). I was given lemon juice with a lot of salt to help get some electrolytes back into my body, as well as spoonfuls of olive oil to help move anything out of my system that was otherwise perpetuating my condition. I was also attended to by King, the local energetic healer who gave me a type of treatment similar to reflexology and who insisted that we didn't say thank you or offer payment. When the treatment was finished, he left through the front door without turning around to say goodbye but returned moments later to share some wine with those in the house who were not afflicted by gastro.

A combination of these treatments eventually exorcised the demon from my system. My mother-in-law arrived at our house that evening with a tea for me. The tea was made with guava (Psidium guajava) leaves and acted as a powerful astringent. A little too powerful, as I was still a little out of my body and drank more than I needed, thus turning my poor stomach into a shrunken prune-like organ. From the Myrtacae family, the plant from the guava plant are shown to have antidiarrhoeal, antimicrobial, antitussive, antiamoebic, CNS depressant, with the stems having a specific astringent quality and the roots being indicated for diarrhea in children (21).

Speaking to most people outside of the island nation, the consensus is that Cuba has the best heath care system in the world. I am not remotely close to being an authority on this subject. I was, however, fortunate enough to visit the Centre for Genetic Engineering and Biotechnology Centre (CIGB) in Havana in 2014 as part of a conference on Oxidative Stress. The representative spoke about the low incidence and prevalence of infectious diseases, such as HIV, the low infant mortality rate and the enormous amount of vaccine research that Cuba undertakes. The small island nation exports millions of dollars' worth of vaccines each year. One vaccine that was discussed in detail is used in the management of diabetic ulcers, Heberprot-P. Essentially, human epidermal growth factor is injected into the ulcer over a period of weeks. The before and after photos were impressive and, by all accounts, are reducing the incidence of morbidity and mortality associated with diabetic foot ulcers, particularly amputations (down by up to 78%) (22).

Cuba is a land full of beauty. Beautiful people, beautiful culture, beautiful landscapes. I truly feel as though the doors to my heart open in a grand gesture to welcome everything while I am there. The warmth of the people enriches me, humbles me and reminds me to walk through life with more grace, albeit with a little bit of salsa in my swag. It is also a land of tradition and rich with holistic medicinal approaches that are truly inspiring and encouraging. Cuban phytotherapy is a fascinating aspect of this Caribbean paradise and a lovely reminder that we are a part of a global herbal medicine community. As I continue to navigate along this path and discover what other cultures use to keep their people well, it is exciting to know that there is still so much to discover.

References

(1.) World O Meters. Cuba Population. 2018. http://www.worldometers. info/world-population/cuba-population/ (accessed 15 April 2018).

(2.) Hunt N. Cuba Climate. 2018. http://www.cubaweather.org/cuba_ climate.php (accessed 13 April 2017).

(3.) Hunt N. Baracoa. 2018. http://www.baracoa.org/generalinformation/general-information.html (accessed 10 February 2018).

(4.) Population: Baracoa Population. 2015. http://population.city/cuba/ baracoa/ (accessed 10 February 2018).

(5.) San Jose University. The Economic History of Havana, Cuba: A City So Beautiful and Important It Was Once Worth More Than All of Florida (n.d). http://www.sjsu.edu/faculty/watkins/havana. htm(accessed 5 July 2017).

(6.) Hunt N. History of Cacao. (n.d.) http://www.cubaagriculture.org/ cacao.htm (accessed 10 February 2018).

(7.) World Weather Online. Baracoa Monthly Climate Averages (n.d.) https://www.worldweatheronline.com/baracoa-weather-averages/ guantanamo/cu.aspx (accessed 10 July 2017).

(8.) Cuba Debate. Fidel Castro praises nutritious properties of Moringa and Mulberry. 2012. http://en.cubadebate.cu/news/2012/10/24/ fidel-castro-praises-nutritious-properties-moringa-and-mulberry/ (accessed 10 February 2018).

(9.) Mbikay M. 2012. Therapeutic Potential of Moringa oleifera Leaves in Chronic Hyperglycemia and Dyslipidemia: A Review. Frontiers in Pharmacology. In press. doi:10.3389/fphar.2012.00024

(10.) Xiao Y, Xu P Fan H, Baudoin L, Xia W, Bocs S, Xu J, Li Q, Guo A, Zhou L, Li J, Ma Z, Armero A, Issali AE, Liu N, Peng M, Yang Y. 2017. The genome draft of coconut (Cocos nucifera). Giga Science. In press. doi:10.1093/gigascience/gix095

(11.) Hartling L, Milne A, Johnson D, Plint A, Klassen T, Vandermeer B. Steroids and bronchodilators for acute bronchitis in the first two years of life: systematic review and meta-analysis. BMJ 2011. In press. doi:10.1136/bmj.d1714

(12.) Vanzella C, Bianchetti P, Sbaraini S, Vanzin SI, Soares Malecchi MI, Bastos Caramao E, Rodrigues Siqueira I. Antidepressant-like effects of methanol extract of Hibiscus tiliaceus flowers in mice. BMC Complement Altern Med 2012;12:41.

(13.) Concha J, Cavieres LA, Sotes GJ, Hernandez V. Essential oil composition of Baccharis linearis (Ruiz & Pav) Pers and Baccharis paniculata DC leaves from Chile. AJEONP 2014;1(4): 6-8.

(14.) Kanis LA, Antonio RD, Antunes EP, Prophiro, JS, Santos da Silva O. Larvicidal effect of dried leaf extracts from Pinus caribaea against Aedes aegypti (Linnaeus, 1762) (Diptera: Culicidae). Revista da Sociedade Brasileira de Medicina Tropical 2009;42(4):373-376.

(15.) Lodha SR, Shrikant VJ, Bhavin AV, Upadhye MC, Kirve MS, Salunke SS, Kadu SK, Rogye MV. Assessment of the antidiabetic potential of Cassia grandis using an in vivo model. J Adv Pharm Technol Res 2010. In press. doi:10.4103/0110-5558.72429.

(16.) Berenguer B, Sanchez LM, Quilez A, Lopez-Barreiro M, de haro O, Galvez J, Martin MJ. Protective and antioxidant effects of Rhizophora mangle (L). against NSAID-induced gastric ulcers. J Ethnapharmachol 2006;103(2):194-200.

(17.) Uruena C, Cifuentes C, Castaneda D, Arango A, Kaur P Asea A, Fiorentino S. Petiveria alliacea extracts uses multiple mechanisms to inhibit growth of human and mouse tumoral cells. BMC Comp Alt Med 2008. In press. doi:10.1186/1472-6882-8-60.

(18.) Invasive Species Compendium. Petiveria alliacea (Guinea hen weed). 2018. https://www.cabi.org/isc/datasheet/70236 (accessed 2 Jan 2018).

(19.) Dososky NS, Satyal P, Gautam TP, Setzer WN. 2016. Composition and biological activities of Murraya paniculata (L.). Jack essential oil from Nepal. Medicines. In press. doi: 10.3390/ medicines3010007

(20.) EcuRed, Trebol de olor. 2017. https://www.ecured.cu/Trebol_de_ olor (accessed 7 October 2017).

(21.) Dwiwedi B, Mehta B. Chemical investigation of Benzene extract of Psidium guajava (leaves). J Nat Prod Plant Resour 2012;2(1):162-168.

(22.) Centro de Ingenieria Genetica y Biotecnologia, Heberprot-P registered in 23 countries. 2017. http://www.cigb.edu.cu/en/ heberprot-p-registered-in-23-countries/ (accessed 10 July 2017).

(23.) Berlanga J, Fernandez J, Lopez E, Lopez P del Rio A, Valenzuela C, Baldomero J, Muzio V, Raices M, Silva R, Acevedo B, Herrera L. Heberprot-P: A novel product for treating advanced diabetic foot ulcer. MEDICC Rev 2013;15(1):11-15.

Julie Brennan BHSc (Naturopathy)

Senior Lecturer at Southern School of Natural Therapies, Fitzroy, Vic; private practitioner

Contact information

Julie Brennan

Email juliebrennan73@hotmail.com

Caption: Figure 1: Green pharmacy dispensary: typically divided between herbal medicine and pharmaceuticals. Propolis tincture is priced at CUC1.50, which is equivalent to approximately A$2.

Caption: Figure 2: Green pharmacy recommendation poster: a list of herbal options for various conditions, as well as their pharmaceutical counterparts.

Caption: Figure 3: Syrups: Jarabe: syrup, of oregano, Romerillo and Santa Cana for respiratory ailments.

Caption: Figure 4: Romerillo is grown in the family garden to help with respiratory infections, which are all too abundant in a damp, tropical environment.

Caption: Figure 5: Trebol application: the leaf is heated over the stove.

Caption: Figure 6: My husband Pedro's knee is covered in lamb fat and the leaf is wrapped around his knee and held in place for maximum exposure.

Caption: Figure 7: Guaiacum sanctum: a medicinal gift from a friend that we couldn't bring home.

Caption: Figure 8: A decoction of Guaiacum sanctum, to help with my husband's knee pain and inflammation.
Table 1

   Natural products        Pharmacological       Medicine substitute
                                action

Garlic tincture 20%     Analgesic, anti-        Pahomin, naproxen,
                        inflammatory,           piroxicam, ibuprofen
                        hypoglycaemic,
                        antispasmodics

Calendula tincture      Blood tonic,            Rutascorbin,
20%                     healing, anti-          venaton, piroxicam,
                        inflammatory,           naproxen
                        analgesic,
                        antiviral,
                        antiemetic

Aloe cream 25%          Topical healing,        Rutascorbin,
                        anti-inflammatory       venaton, piroxicam,
                                                neproxen,
                                                nitrafurazone

Aloe rectal ointment    Antihaemorrhoidal,      Proctocaine, venaton
2%                      anti-inflammatory

Plantago major fluid    Anti-inflammatory,      Antiseptic solution,
extract, mouthwash      antibacterial,          Halitol (illegible)
                        antiseptic,
                        antifungal, healing

Aloe syrup              Antispasmodic,          Salbutimol,
                        hepatoprotective        theophylline,
                                                pancreatin

Imefasma syrup 50%      Antispasmodic,          Salbutimol,
                        broncodilator,          theophylline,
                        expectorant             ketotifen, vitamin C

Onion and garlic        Antiscorbutic,          Salbutimol,
syrup 10% Oregano       antiasthmatic,          theophylline,
and Chilean Little      broncodilator,          ketotifen, vitamin C
Rosemary syrup          expectorant

Oregano syrup 10%       Expectorant,            Salbutimol,
                        antitussive             theophylline,
                        anticatarrhal           ketotifen, vitamin C

Oregano and Santa       Expectorant,            Theophylline,
Cana syrup              anticatarrhal,          ketotifen
                        antiasthmatic

Indigo plantain         Pediculicide            Permathrin, benzyl
lotion 20%                                      benzoate lotion and
                                                cream

Caribbean pine cream    Antifungal              Micocilen,
10%                                             miconazol,
                                                ketoconazol,
                                                tolnaftate

Caribbean pine fluid    Antibacterial,          Micocilen,
extract                 antifungal              miconazol,
                                                ketoconazol,
                                                tolnaftate

Alcoholic lemon balm    Anti-inflammatory,      Dipyrone tablet and
4%                      analgesic,              suspension,
                        antiseptic              paracetamol tablet

Sour orange tincture    Diuretic,               Hydrochlorothiazide,
                        vasoprotective,         venaton, vitamin C,
                        blood tonic, blood      rutascorbin
                        vessel protector

Kidney tea fluid        Diuretic                Chlorthalidone,
extract                                         hydrochlorothiazide,
                                                furosemide,
                                                spironolactone

Saint cane tincture     Hypotensive,            Captopril,
20%                     diuretic                enalapril,
                                                nifedipine,
                                                propanolol

Canadonga syrup         Antianaemic             Folic acid, ferrous
                                                fumarate

Passionflower, Tilia    Sedative                Nitrazepam,
extract                                         diazepam,
                                                chlordiazepoxide

Red mangrove fluid      Antacid,                Omeprazole,
extract                 antidiarrhoeal          cimetidine,
                                                ranitidine, reasec

Chamomile tincture      Antacid,                Pahomin, novatropin,
                        antidiarrhoeal,         bile salts, charcoal
                        anti-inflammatory,      and pepsin
                        astringent,
                        antimocrobial

Sage syrup 15%          Anti-inflammatory,      Salbutamol, JB
                        expectorant,            theophylline, JB
                        antitussive             ketotifen

Japanese mint           Antispasmodic tonic,    Charcoal and pepsin,
tincture, peppermint    carminative,            pepsiclor,
fluid tincture          cholagogue              novatropin, bile
                                                salts, pahomin

Honey with garlic       Hypocholesterolaemic    Ppg, cholestyramine
(hypolipodaemic)

Propolis tincture       Antiparasitic           Tinidazole,
5%, 10%, 30%            (Giardia),              metronidazole,
                        antibacterial           secnidazole

Onion cream             Fungicidal,             Nitrafurazone,
                        antibacterial, anti-    clobetasol,
                        inflammatory            triamcinolone

Ginger, orange          Antirheumatic           Mentolan, vaposan,
jasmine rub                                     ibuprofen,
                                                indomethacin,
                                                naproxen

Shampoo with orange,    Hair growth/            Pitch shampoo,
beach hibiscus, aloe    revitaliser,            placenta
and chamomile           antiseborrhaic

Guinea hen weed         Anti-inflammatory,      Mentolan cream,
ointment                analgesic,              (illegible), vaposan
                        antipyretic,            cream (illegible),
                        anaesthetic             ibuprofen tablets,
                                                indomethacin
                                                tablets, naproxen
                                                tablets, nasalan

Pumpkin capsule         Antioxidant, anti-      Secnidazole tablets,
                        inflammatory,           metronidazole
                        antiprostatic,          tablets, mebendazole
                        antioedema, diuretic    tablets, oral
                                                analgesics.

Calendula syrup 10%     Anti-inflammatory,      Ibuprofen, naproxen,
                        antiviral, blood        piroxicam, venaton
                        tonic, antipsasmodic    drops, pahomin drops

Santa Cana syrup 10%    Antipyretic,            Dipyrone,
                        diuretic,               paracetamol, pahomin
                        antioxidant,            drops
                        antispasmodic

Guava tincture 20%      Antidiarrhoeal,         Rehydrating salts,
                        antispasmodico,         pahomin drops,
                        sedative, haemolytic    chlordiazepoxide

Guava powder,           Antibacterial,          Triamcinolone,
chamomile flowers       fungicidal              ketoconazole,
                                                tolnaftate,
                                                micocilen ointment

Chamomile cream         Antibacterial, anti-    Triamcinolone,
                        inflammatory,           ketoconazole,
                        antiseptic,             tolnaftate,
                        antioxidant             micocilen ointment,
                                                clobestasol cream

Chilean Little          Hypoglycaemic           Glibenclamide,
Rosemary liquid                                 tolbutamide,
extract                                         glibepiridine.

Guava talcum            Antibacterial,          Micocilen talc,
                        fungicidal              micocilen ointment.

Vigman cream            Antioxidant             Vitamin complex
(translation not                                (nutritional
found), aqueous and                             supplement)
syrup
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Author:Brennan, Julie
Publication:Australian Journal of Herbal and Naturopathic Medicine
Date:Jun 1, 2018
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