Usage and adverse effects of Chinese herbal medicines

Oestrogen receptor (ER) expression in breast cancer is regarded as a phenotype that may change during the natural history of the disease or during endocrine therapy. It has been suggested that in up to 70% of tumours that show acquired resistance the mechanism may be changed in ER status from positive to negative. This paper proposes an alternative hypothesis that ER expression in a stable phenotype in breast cancer. The paper reviews the literature on ER expression during the natural history of breast cancer in patients and also presents data on the effect of endocrine therapy on ER expression. If the alternative hypothesis is true it has important implications for treatment from chemoprevention to acquired endocrine resistance in advanced disease. Equally, if the hypothesis is true, attempts to develop laboratory models of endocrine resistance where ER-positive tumours become ER negative need to be re-evaluated.     

Aconitine poisoning following the ingestion of Chinese herbal medicines: a report of eight cases

BACKGROUND: Traditional Chinese medicines often contain 'chuanwu' and 'caowu', the roots of certain Aconitum species which are thought to have an anti-inflammatory effect in many conditions. Excessive amounts of these materials, which contain diterpene alkaloids particularly aconitine, can produce toxic effects and occasional fatalities. AIMS: This study was conducted to document the adverse effects related to these herbal medicines which resulted in hospital admission and to determine the outcome in these patients. METHODS: A retrospective survey was conducted of patients admitted to the Prince of Wales Hospital, Hong Kong with suspected adverse effects from Chinese herbal medicines containing chuanwu or caowu over a two year period from 1989 to 1991. RESULTS: Eight patients were identified with features of mild to moderate intoxication including nausea and vomiting, paraesthesiae or numbness in the mouth and extremities, hypotension and ventricular extrasystoles. The management of aconitine poisoning is essentially supportive and in-hospital observation with ECG monitoring should be continued for at least 24 hours because of the risk of cardiovascular collapse and ventricular arrhythmias. The medical profession and general public should be alerted to the potential toxicity of these herbs and their usage should be controlled by legislation in Hong Kong as it is in some other countries.     

Direct effects of Chinese herbal medicine "hochuekkito" on sperm movement

BACKGROUND AND PURPOSE: Chinese herbal medicine, "Hochuekkito" is widely used for male infertility in Japan. There have been many reports concerning its clinical usefulness but very few reports of in vitro experiments studying the mechanism of its effects. In addition to stimulating germ cells, we analyzed its direct effects on sperm using computer assisted semen analyzer (CASA). MATERIALS AND METHODS: Motile sperm were prepared using swim up technique from semen collected from ten healthy volunteers. Sperm movements (motility, velocity, linearity) were analyzed by CASA after adding either serum containing anti-sperm antibody (ASA) or normal serum with or without Hochuekkito. RESULTS: Two hours after adding serum with ASA, the decrease of sperm motility was significantly reduced from 25.1% (92.8%-->67.7%) to 12.5% (92.9%-->80.6%) by adding Hochuekkito. No significant difference in velocity and linearity was observed between two groups. By adding normal serum, any of three parameters differed significantly with or without Hochuekkito. CONCLUSION: Protective effects of Hochuekkito on sperm was suggested. Although normal sperm with ASA was used in this report, since the sperm of infertile patients are said to be more fragile, this results imply that direct protective effect is one of the mechanism of Hochuekkito for male infertility.     

Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial

CONTEXT: Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment. OBJECTIVE: To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997. SETTING: Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group. MAIN OUTCOME MEASURES: Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients. RESULTS: Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.     

Anti-Helicobacter pylori activity of herbal medicines

The extracts of Coptidis japonica (rhizoma), Eugenia caryophyllata (flower), Rheum palmatum (rhizoma), Magnolia officinalis (cortex) and Rhusjavanica (galla rhois) potently inhibited the growth of Helicobacter pylori (HP). However, these herbal extracts showed no inhibitory effect on HP urease except Galla rhois. Among the components separated from active herbal extracts by silica gel column chromatography, the inhibitory effects of decursinol angelate and decursin on the growth of HP were the most potent, followed by magnolol, berberine, cinnamic acid, decursinol and gallic acid. Minimum inhibitory concentrations (MICs) of decursin and decursinol angelate were 6-20 microg/ml.     

Preliminary screening of Chinese herbal medicine in inhibiting Helicobacter pylori

At present Helicobacter pylori (HP) was taken to be closely related to chronic atrophic gastritis and peptic ulcer. 226 patients with symptoms of upper digestive tract by endoscope were examined and chronic atrophic gastritis and peptic ulcer were diagnosed. Mucous membrane from gastric antrum was taken and cultured, and found that 136 cases of 226 patients were HP positive and the rate of positiveness was 60.18%. 200 kinds of Chinese herbal medicine were selected to investigate its inhibitory action on HP. Results indicated that 38 among 200 kinds of Chinese herbal medicine had inhibitory effects on HP, which provided evidence for diagnosis and treatment of chronic atrophic gastritis and peptic ulcer, also for inhibition of HP growth.     

The use of Chinese herbal medicine on experimental fracture healing

Current therapy for primary systemic (AL) amyloidosis has only modest efficacy (response rate 25%) and because it includes alkylating agents, it has a significant leukemogenic potential (actuarial risk 21% at 3.5 years). We treated 9 consecutive patients with biopsy proven AL amyloidosis seen at our institution with pulse dexamethasone induction (40 mg on days 1-4, 9-12, 17-20 repeated q 35 days) for 3-6 cycles followed by maintenance alpha interferon 3-6 million units thrice weekly. Three patients also received maintenance dexamethasone (40 mg/day x 4 days q 4-8 weeks) for the first year. Improvement in > or = 1 AL organ involvement was seen in 8 of 9 patients. Of 7 patients with nephrotic range proteinuria, 6 had > or = 50% reduction in nonspecific proteinuria with a median time to response of 4 months (range 3-9 months). Marked improvement in organ function was also seen in 4 patients with gastrointestinal, hepatic and neuropathic involvement. However, none of the 2 patients with congestive heart failure improved. This dexamethasone plus alpha interferon regimen, devoid of leukemogenic potential, may lead to rapid and durable improvement in organ function in a significant proportion of patients with AL amyloidosis and deserves further evaluation as front line therapy.     

Complementary medicine: use and attitudes among GPs

BACKGROUND: Information about use and attitudes of GPs towards complementary medicine is required in order to inform the debate about its place within mainstream medicine. There is evidence that public use of complementary medicine is particularly high in the South-West of England. OBJECTIVE: This study aimed to determine the use of, and attitudes towards, complementary medicine among GPs. METHODS: A questionnaire survey was performed of all primary care physicians working in the health service in Devon and Cornwall. RESULTS: Replies were received from 461 GPs, a response rate of 47%. A total of 314 GPs (68%, range 32-85%) had been involved in complementary medicine in some way during the previous week. One or other form of complementary medicine was practised by 74 of the respondents (16%), the two most common being homoeopathy (5.9%) and acupuncture (4.3%). In addition, 115 of the respondents (25%) had referred at least one patient to a complementary therapist in the previous week, and 253 (55%) had endorsed or recommended treatment with complementary medicine. Chiropractic, acupuncture and osteopathy were rated as the three most effective therapies, and the majority of respondents believed that these three therapies should be funded by the health service. A total of 176 (38%) of respondents reported adverse effects, most commonly after manipulation. CONCLUSION: Over two-thirds of the GPs in Devon and Cornwall who responded to the survey had been involved with complementary medicine in some way during the previous week. This figure is higher than the national average. The majority of respondents believed that acupuncture, chiropractic and osteopathy were effective and should be funded by the NHS.     

Profiles of effects of traditional oriental herbal medicines on central nervous systems in humans--assessment of saiboku-to and saiko-ka-ryukotsu-borei-to using EEG and pharmacokinetics of herbal medicine-derived ingredients as indices

To elucidate usefulness of traditional oriental herbal medicines in psychiatric fields, we investigated their influences on central nervous systems in humans by using EEG and pharmacokinetics of herbal medicine-derived ingredients as the indices. The subjects were 12 healthy male volunteers who received single oral administration and after that received repeated oral administrations at a daily dose of Saiko-ka-ryukotsu-borei-to or Saiboku-to; EEG was recorded before administration, 1, 3, 6 hours and 10 days after administration. On direct comparison of global field powers calculated from 19-lead EEG before and after administration, it was verified that Saiboku-to possessed effects on central nervous systems. For assessment of pharmacokinetics of ingredients derived from Saiboku-to, pre- and post-treatment serum samples were assayed by HPLC and two ingredients were detected, besides individual differences being observed in their pharmacokinetic profiles. Given that these pharmacokinetics could be interpreted as the phenomena associated with Sho (traditional physical status classifications of patients), the subjects were classified into groups according to individual differences whereby quantitative pharmaco-EEG were employed to elucidate neurotropic effects of Saiboku-to. As the result, following two groups were evidenced: (1) a group demonstrating the mood elevator type after a single administration despite of no changes after repeated administrations, and (2) a group with a shift from the mood elevator type to the nootropics type being observed over time, delineating overt differences in EEG profiles among groups. Consequently, individual differences were evidenced to be involved in onset of neurotropic effects of Saiboku-to, permitting prediction of possible responses following repeated administrations by using EEG profiles. It was also suggested that neurotropic effects of respective ingredients could be anticipated by monitoring the time-course changes of both EEG and plasma levels of these ingredients. In summary, once further studies on oriental herbal medicines might progress based on efficacy assessments of respective ingredients with a clue of the present study, it is conceivable that these findings would play an important role as the objective indices in clinical application of herbal medicines in psychiatric fields, resulting in broadening the usefulness of oriental herbal medicines.     

Complementary medicine: legal status of the non-licensed provider in the USA

European providers of complementary medicine may be surprised by the formal strictures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic health care, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.     

Compatibility of toxic Chinese medicines]

This article expounds the suitable compatibility and incompatibility in using toxic Chinese medicines in respects of reducing toxicity, raising curative effect, enhancing toxicity and reducing curative effect. Meanwhile it discusses the compatibility mechanism of toxic Chinese medicines in combination with the studies of clinical and modern experiments.