Herbal Medicine.

Chinese herbal mixture cures a leukaemia patient

American oncologists report the case of a man with chronic lymphocytic leukaemia (CLL) who, in the absence of cytotoxic chemotherapy, began taking a Chinese herbal extract. Shortly thereafter, he experienced a steady decline of his lymphocytosis and adenopathy, and he remains in remission over 10 years later. The herbal extract inhibited the survival of primary CLL cells under in vitro culture conditions. However, it did not inhibit the activation of Akt or mitogen‐activated protein kinase, neither did it inhibit the serine phosphorylation of STAT1. Thus, through an as yet unknown mechanism, this extract appears to exert pro‐apoptotic effects in CLL.

Beat severe acute respiratory syndrome with the liquorice stick!

At present, no specific treatment has been identified for severe acute respiratory syndrome (SARS)‐associated coronavirus infection. German researchers assessed the antiviral potential of ribavirin, 6‐azauridine, pyrazofurin, mycophenolic acid and glycyrrhizin against two clinical isolates of coronavirus (FFM‐1 and FFM‐2) from patients with SARS admitted to the clinical centre of Frankfurt University, Germany. Of all the compounds, glycyrrhizin, an active component of liquorice root, was the most active in inhibiting replication of the SARS‐associated virus. These findings suggest that glycyrrhizin should be assessed for treatment of SARS.

Cannabis sativa not causally related to schizophrenia

This study modelled the effects on the prevalence of schizophrenia over the lifespan of Cannabis sativa in eight birth cohorts: 1940–1944, 1945–1949, 1950–1954, 1955–1959, 1960–1964, 1965–1969, 1970–1974, 1975–1979. It derived predictions as to the number of cases of schizophrenia that would be observed in these birth cohorts, given the following four hypotheses: (1) that there is a causal relationship between C. sativa use and schizophrenia; (2) that C. sativa use precipitates schizophrenia in vulnerable persons; (3) that C. sativa use exacerbates schizophrenia; and (4) that persons with schizophrenia are more liable to become regular cannabis users. There has been a steep rise in the prevalence of C. sativa use in Australia over the past 30 years and a corresponding decrease in the age of initiation of use. There was no evidence of a significant increase in the incidence of schizophrenia over the past 30 years. Data on trends for the age of onset of schizophrenia did not show a clear pattern. C. sativa use among persons with schizophrenia has consistently been found to be more common than in the general population. The authors concluded that C. sativa use does not appear to be causally related to the incidence of schizophrenia, but its use may precipitate disorders in persons that are vulnerable to developing psychosis and worsen the course of the disorder among those that have already developed it.

Eleutherococcus senticosus is not a hepatic enzyme inducer

Eleutherococcus senticosus (Siberian ginseng) is a commonly used herbal preparation. The objective of this study was to assess in normal volunteers the influence of a standardised E. senticosus extract on the activity of cytochrome P450 CYP2D6 and 3A4. Probe substrates dextromethorphan (CYP2D6 activity) and alprazolam (CYP3A4 activity) were administered orally at baseline and again following treatment with E. senticosus (1 × 485 mg twice daily) for 14 days. Urinary concentrations of dextromethorphan and dextorphan were quantified, and dextromethorphan metabolic ratios (DMRs) were determined at baseline and after E. senticosus treatment. Similarly, plasma samples were collected (0–60 h) for alprazolam pharmacokinetics at baseline and after E. senticosus treatment to assess effects on CYP3A4 activity. Validated high‐performance liquid chromatography methods were used to quantify all compounds and relevant metabolites. There were no statistically significant differences between pre‐ and post‐ E. senticosus treatment DMRs indicating a lack of effect on CYP2D6. For alprazolam there also were no significant differences in the pharmacokinetic parameters determined by non‐compartmental modelling, indicating that E. senticosus does not significantly induce or inhibit CYP3A4. Our results indicate that standardised extracts of E. senticosus at generally recommended doses for over‐the‐counter use are unlikely to alter the disposition of co‐administered medications primarily dependent on the CYP2D6 or CYP3A4 pathways for elimination.

Piper methysticum as effective as synthetic anxiolytics

An 8‐week randomised, reference‐controlled, double‐blind, multicentre clinical trial investigated kava kava LI 150 in generalised anxiety disorder (GAD; ICD‐10). A total of 129 outpatients received 400 mg Kava LI 150, 10 mg buspirone or 100 mg Opipramol daily for 8 weeks. At week 9, subjects were seen to check for symptoms of withdrawal or relapse. Primary outcome measures were the HAMA scale and the proportion of responders at week 8. No significant differences could be observed for efficacy and safety measures. About 75% of patients were classified as responders (50% reduction of HAMA score) in each treatment group and about 60% achieved full remission.

An analysis of 29 cases of Piper methysticum‐related hepatotoxicity

German authors analysed 29 novel cases of hepatitis associated with Piper methysticum ingestion, which occurred between 1990 and 2002, in addition to seven published case reports using a clinical diagnostic scale established for adverse hepatic drug reactions. Hepatic necrosis or cholestatic hepatitis was noticed with both alcoholic and acetonic P. methysticum extracts. The majority of the 29 patients and the additional seven published reports were women (27 females, nine males). Both the cumulative dose and the latency to when the hepatotoxic reaction emerged were highly variable. Nine patients developed fulminant liver failure, of which eight patients underwent liver transplantation. Three patients died, two following unsuccessful liver transplantation and one without. In all other patients, a complete recovery was noticed after the withdrawal of P. methysticum. Pathophysiologically, both immuno‐allergic and idiosyncratic factors may be responsible.

Crataegus for CHD‐related congestive heart failure

Coronary heart disease (CHD) is one of the main causes of heart failure. An early and well‐tolerated medication for long‐term treatment is required to improve the quality of life and prognosis. In many countries, herbal medication is a frequently used therapeutic approach for a variety of diseases including chronic heart failure. Crataegus extract WS 1442 is a dry extract from hawthorn leaves and flowers containing 18.75% oligomeric procyanidines. To evaluate the effect of WS 1442 in patients with heart failure and CHD‐related congestive heart failure, four studies with New York Heart Association classes II‐III patients were analysed. After treatment with Crataegus extract WS 1442, patients with heart failure and CHD showed a significant improvement in left‐ventricular ejection fraction compared with placebo. In addition, an increase in the difference in the pressure–heart‐rate product and in the maximal work load was observed, indicating a favourable effect of WS 1442 in the treatment of CHD‐related congestive heart failure.

Crataegus for chronic heart failure

The aim of this meta‐analysis was to assess the evidence from rigorous clinical trials of the use of Crataegus spp. extract to treat patients with chronic heart failure. The authors searched the literature using Medline, EMBASE, the Cochrane Library, CINAHL, CISCOM, and AMED. Experts on and manufacturers of commercial preparations containing Crataegus extract were asked to contribute published and unpublished studies. There were no restrictions on the language of publication. Two reviewers independently performed the screening of studies, selection, validation, data extraction, and the assessment of methodological quality. To be included, studies were required to state that they were randomised, double‐blind and placebo‐controlled, and used Crataegus extract mono‐preparations. A total of 13 trials met all inclusion criteria. In most of the studies, Crataegus spp. was used as an adjunct to conventional treatment. Eight trials including 632 patients with chronic heart failure (New York Heart Association classes I to III) provided data that were suitable for meta‐analysis. For the physiological outcome of maximal workload, treatment with Crataegus spp. extract was more beneficial than placebo (weighted mean difference, 7 W; 95% CI 3–11 W; P < 0.01; n = 310 patients). The pressure–heart‐rate product also showed a beneficial decrease (weighted mean difference, −20; 95% CI −32 to −8; n = 264 patients) with Crataegus treatment. Symptoms such as dyspnoea and fatigue improved significantly with Crataegus spp. treatment compared with placebo. Reported adverse events were infrequent, mild and transient; they included nausea, dizziness, and cardiac and gastrointestinal complaints.

Crataegus as effective as ACE Inhibitor

The efficacy of the Crataegus preparation Cralonin was tested for non‐inferiority to standard treatment for mild cardiac insufficiency in a multicentre non‐randomised cohort study in patients with congestive heart failure of New York Heart Association class II. Patients received Cralonin (n = 110) or angiotensin‐converting enzyme (ACE) inhibitor/diuretics (n = 102) for 8 weeks. To adjust for confounding by baseline factors, populations were stratified according to propensity score. After adjusting, there were no statistically significant differences between treatment groups. Treatment efficacy was assessed on 15 variables. A stringent non‐inferiority criterion for the upper limit of the 97.5% one‐sided CI of the treatment difference was set to 0.2× the SD. Both treatment regimens improved scores on most variables studied, with the greatest effect on double product after exercise (average score reduction 15.4% with Cralonin vs. 16.0% for the control group). Non‐inferiority of Cralonin was demonstrated on seven variables. Both treatments were well tolerated.

How safe is Cimicifuga racemosa?

Systematic literature searches were conducted in seven electronic databases, and the reference lists of all papers located were checked for further relevant publications. Information was also sought from the spontaneous reporting programmes of the WHO and national drug safety bodies. A total of 16 manufacturers of Cimicifuga racemosa (black cohosh) preparations were contacted and asked for data held on file. Finally, the researchers’ own departmental files were searched. No language restrictions were imposed. Combination products and homoeopathic preparations were excluded. Data from clinical studies and spontaneous reporting programmes suggest that adverse events (AEs) with C. racemosa are rare, mild and reversible. Gastrointestinal upsets and rashes are the most common AEs. The spontaneous reporting programmes do contain a few serious AEs, including hepatic and circulatory conditions, but causality cannot be determined. Although there is a large amount of data investigating the efficacy of C. racemosa, in particular the product Remifemin, safety issues and the monitoring of AEs have not been the focus.

Healthcare professionals’ knowledge about herbal medicine

A cross‐sectional survey was conducted of USA clinicians prior to participation in an Internet‐based educational programme on herbs and dietary supplements. The 537 participants included 111 physicians (MDs), 30 advanced practice nurses (RNs), 46 pharmacists (PharmDs) and 350 dieticians (RDs). In addition to demographic information, participants were asked about their knowledge, attitudes, and practices related to herbs and other dietary supplements. Most participants were involved in direct patient care (85%), in practice or on faculty (84%), and from outside our local institutions (76%); 66% reported receiving professional education about herbs and other dietary supplements in the past year. There were statistically significant differences between professional groups, with RDs scoring better than others, but even their average scores were less than 60% of possible. The average score on knowledge questions was 10/20; the average confidence score was 4 out of 10 possible, and the average communication score was 1.4 out of 4 possible. Most respondents knew the most common clinical uses of echinacea and St John's wort, and felt confident that they knew more than their colleagues about herbs and dietary supplements. Key deficits were in knowledge about adverse effects, confidence in reporting side‐effects, routinely communicating with patients about herbs and dietary supplements, and recording herbs and dietary supplements information in the medical record.

Ginkgo biloba, a platelet inhibitor

Enhanced platelet function, particularly in response to collagen, is a common occurrence in diabetes that increases the risk of cardiovascular disease. Ginkgo biloba extract is ingested primarily to improve mental focus but it also possesses a blood‐thinning potential, which has not been well characterised. This study was designed to compare the effect of ingesting G. biloba extract on platelet aggregation in platelet‐rich plasma (PRP) and prostanoid urinary excretion in healthy volunteers and subjects with Type 2 diabetes mellitus (T2DM). Before and after ingesting 120 mg of standardised G. biloba extract for 3 months, platelet aggregation was studied in PRP, and urinary metabolites of thromboxane B2 (TXB2) and prostacyclin (PGI2) were measured. In healthy volunteers, the ingestion of G. biloba extract significantly increased fasting insulin and C‐peptide and significantly reduced collagen but not platelet‐activating factor (PAF)‐mediated platelet aggregation, converting 21 of 28 subjects with [COL + /EPI +] platelets to the [COL − /EPI +] phenotype. This was accompanied by a reduction of 11‐dehydro‐TXB2 and PGI2. In the T2DM subjects, G. biloba ingestion did not affect pancreatic β‐cell function but significantly reduced platelet aggregation, converting 16 of 19 [COL + /EPI +] platelets to the [COL − /EPI +] phenotype. Unlike the healthy volunteers, this was not accompanied by a reduced urinary prostanoid excretion.

Herbal supplement use in USA

A total of 500 female outpatients were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic and 1.5% Asian, with a mean age of 50.34 years. Botanical dietary supplements (BDS) were used by 79% of respondents (n = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), Camellia sinensis (green tea) (34.68%), Chamomilla spp. (chamomile) (20.76%), Gingko biloba (20.51%), ginseng (17.97%), Echinacea spp. (15.44%), and Hypericum perforatum (St John's wort) (7.34%). Cimicifuga racemosa (black cohosh), Allium sativum (garlic), Trifolium pratense (red clover), Piper methysticum (kava), Valeriana officinalis (valerian), Oenothera biennis (evening primrose) and Ephedra sinica were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side‐effects. Only 3% of respondents obtained BDS information from healthcare professionals and 70% of respondents were not informing their physician of BDS use.

Antibacterial herbs from Kenya

Aqueous, hexane and methanol extracts of 12 plant species, traditionally used in Kenya for treatment of ailments of an infectious and/or inflammatory nature were screened for in vitro antibacterial and anti‐inflammatory activities. Antibacterial activity was tested using the agar diffusion method while anti‐inflammatory activity was tested using the cyclo‐oxygenase (COX‐1) assay. All the antibacterial activity was against Gram‐positive bacteria, with nine plant species showing some activity against Staphylococcus aureus. The highest activity was found in the methanol extracts of Maytenus senegalensis, Plectranthus barbatus, Zanthoxylum chalybeum, Zanthoxylum usambarense and hexane extracts of Spiranthes mauritianum. All the plant species showed some anti‐inflammatory activities. In most cases, methanol extracts caused higher inhibition than aqueous and hexane extracts.

Kampo against chemotherapy‐induced diarrhoea

The kampo medicine Hangeshashin‐to (TJ‐14), which contains baicalin, a β‐glucuronidase inhibitor, alleviates diarrhoea induced by irinotecan (CPT‐11). Japanese researchers conducted a randomised comparative trial to investigate whether support with TJ‐14 would prevent and control CPT‐11‐induced diarrhoea. Of 44 previously untreated patients with advanced non‐small‐cell lung cancer, 41 (18 in the TJ‐14 group; 23 in the control group) were available for evaluation. The chemotherapy regimen consisted of a combination of cisplatin and CPT‐11. TJ‐14 (7.5 g/day) was administered orally. Of the 41 patients, 39 experienced diarrhoea. Compared with the control group, the TJ‐14 group showed a significant improvement in diarrhoea grades as well as a reduced frequency of diarrhoea grades 3 and 4. However, the two groups showed no differences in the frequency of diarrhoea or the number of days the symptoms continued.

Ayurveda for osteoarthritis

One of the ingredients most commonly found in Ayurvedic arthritis formulae is guggul, an oleoresin of the herb Commiphora mukul. This study was conducted using an outcome, quasi‐experimental, model. A total of 30 participants suffering from osteoarthritis, with a score of 2 or more on the Kellegran–Lawrence scale for at least one knee, were admitted. Commiphora mukul was administered in capsule form (500 mg concentrated exact delivered t.i.d.) along with food. The WOMAC Total Score was used as a primary outcome measure; VAS scales, 6‐minute walk‐test, and WOMAC subscales were used as outcome measures. At the end of treatment, there was a significant difference in the scores of the primary and secondary outcome measures. On the primary measure, WOMAC total score, participants were significantly improved after taking the supplement for 1 month and continued to improve at the 2‐month marker and follow‐up.

Herbal medicines for rheumatoid arthritis

The purpose of this study was to conduct a systematic review to examine evidence for the use of herbal medicines for rheumatoid arthritis based on RCTs. Computerised searches of eight electronic databases and the bibliographies of identified articles resulted in 14 studies meeting the inclusion criteria. Two raters independently extracted data and rated the trials for quality. There is moderate support for γ‐linolenic acid, which is found in some herbal medicines, for reducing pain, tender joint count and stiffness. For other herbal medicines there was only a single RCT available, resulting in weak evidence. In general, herbal preparations were relatively safe to use.