(CHINESE) HERB NEWS
Herbs in this issue:
A Note From Dr. Leung
My primary reason for publishing this newsletter is to try to counteract the misinformation on herbs, especially Chinese herbs, which is increasingly being distributed by various media. There is so much of this misinformation floating around that it is impossible to even address a tiny fraction of it. Hence my approach to this problem cannot be systematic. Rather, it is more like hit or miss, taking on only the most outrageous. One such piece of work has just been brought to my attention by a colleague and friend who is also not shy in expressing his opinions on offensive literature, regardless of where it has appeared.
The article in question is published as a review article in a prestigious medical journal [Arch. Intern. Med., 158: 2200-2211(1998)]. Written by a Pharm D (doctor of pharmacy), the paper is titled “Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions.” It deals with some of the most commonly used herbs, including chamomile, echinacea, feverfew, garlic, ginger, ginkgo, “ginseng”, saw palmetto, St. John’s wort, and valerian. However, it is so poorly written
Dr. Leung is author of the Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics (Wiley-Interscience), which was published in 1980 and revised in 1996. He is also creator of PHYTOMED, a prototype computer database on Chinese herbal medicine developed under contract with the National Cancer Institute.
that it will probably go down in infamy as the notorious “ginseng abuse syndrome” article.1 I am sure some of my colleagues will address in some manner the misinformation on the Western herbs reviewed in this article. What I want to concentrate on is the Chinese herb “ginseng.” I usually can make a quick judgement about a lengthy article on herbs by selectively reviewing its information on just one or two of the herbs. If this information is poor, disorganized, or downright wrong, there is a good chance that the rest of the article is no better. This certainly applies to the above-mentioned article.
First of all, although the author seems to have a vague idea about Siberian ginseng (Eleutherococcus senticosus) being different from regular “ginseng,” she has no clue that there is a distinction between Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius). Also, by quoting the infamous “ginseng abuse syndrome” article, she reveals herself as one of so many pharmacists and conventional medical personnel who are totally ignorant about “ginseng” research. I have already written about the “ginseng abuse syndrome” article in my Encyclopedia and in this Newsletter (Issue 3, pp. 2-3); suffice to say that despite voluminous publications on results of “ginseng” research, only a handful has correctly identified the source and type of ginseng being used. This all boils down to “identity, identity, and identity” when it comes to using herbs in research or consuming them as medicines or supplements. Herbs are not like pure chemicals; the latter are well defined (e.g., ephedrine is ephedrine and cocaine is cocaine) and can be identified by their common or chemical names. Even so, many chemicals come in different isomeric forms; one often is biologically active while another is not. When we deal with herbs, the problem is even more complicated. Herbs cannot be identified simply by some plant names, because the plant names themselves are not the materials used. Rather, the particular forms in which they physically end up or the way they have been prepared (extracted or simply powdered) make a whole world of difference. In the case of “ginseng,” if one does not know the differences among different types of ginseng in terms of their traditional properties and uses, one may as well compare apples with pears. These fruits are both from the rose family, but you and I know that they are distinctly different fruits. Why do major medical journals insist on publishing these types of research papers without subjecting them to review by scientists who are knowledgeable in these matters? This is something I still have not figured out after reading many grossly inferior papers published in such journals over the past several years. Also, why do people who have no concept of what is going on in the herbal field keep writing about herbs without collaborating, or at least consulting, with someone who is knowledgeable? Instead of dissecting this article, let’s simply look at the first few sentences that describe ginseng: “Wide variation exists among ginseng products. Ginsenoside extraction methods have found Panax quinquefolius in American ginseng, Panax ginseng in Oriental ginseng, and Panax pseudoginseng var notoginseng in Sanchi ginseng. Panax-type ginsenosides were not detected in Siberian ginseng that instead contains Eleutherococcus senticosus……” I need some help here, because I have no idea what she is talking about. When I read the first sentence, I said to myself, “Right on!” Then, as I continued to read, I was very disappointed. It was obvious that an amateur was trying to play pro, covering her ignorance of the topic with double talk.” What does the author mean by the second sentence? Is this a new terminology for presenting information on herbs to our pharmaceutical and medical colleagues of which I am not aware? Can an extraction method find a scientific name in a common name? Is this poetry? I know I am not that up to date with pharmaceutical terminology. But am I that out of it? Then, there is the third sentence. Does it mean that there are actually non-Panax-type ginsenosides present in eleuthero (Siberian ginseng) which are not present in either Asian or American ginseng? Or does Siberian ginseng contain Eleutherococcus senticosus, as in, “Albert Leung contains Yuk-sing Leung,” my other name? Is this new English, as in new math? The logic escapes me. How can anyone in such a few short sentences make the topic so confusing? I believe the answer is because she is confused. Some of you may think I am splitting hair. But my thinking is that, if an author, as an authority, does not know the subject or is incapable of presenting it in a logical and understandable manner, he or she has no business writing the article. And the fact that such an article is even being published does not speak well for the journal’s editorial board. For those who want to quote this article, my advice is to check the original references cited, to be sure the materials being studied were precisely defined, otherwise you will be guilty of perpetuating the dissemination of misinformation and ignorance. Also, watch for letters to the journal editors, because I am sure some of my colleagues will be writing them, unless, of course, the editors are too embarrassed to publish them.
(1) R.K. Siegel, “Ginseng abuse syndrome,” JAMA, 241:1614-1615(1979); Leung, A.Y. and S. Foster, Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd Ed., Wiley-Interscience, New York, 1996, pp. xv, 225-227, 277-281, 495-498; Leung, A.Y., Better Health with (Mostly) Chinese Herbs & Food, AYSL Corp., Glen Rock, N. J., 1995, pp. 24, 25, 42, 43.
How Good are Independent Laboratories?
If you are a manufacturer of herbal ingredients or finished products, sooner or later you will have to deal with independent testing labs, and it doesn’t matter whether or not you have your own analytical facilities. You need to verify your own test results, at least once in a while, by an outside lab. There are many analytical labs that do routine simple tests such as protein, amino acids, vitamins and minerals, microbial profiles (total plate count, pathogens, yeast and mold, etc.), heavy metals, and pesticides. Even with these assays, there are often errors. And when it comes to more sophisticated assays such as ginsenosides, kavalactones, flavonoids, and lignans, everything seems to break loose. First of all, there are only a handful of commercial labs that do (or at least profess to do) these assays, hence your choice is rather limited. Furthermore, the prices of these assays are so artificially high that few companies can afford to send duplicate (blind) samples. The result is that often you can’t trust the test results. Over the past few years, I have personally experienced inconsistencies and even totally wrong results reported by a few of the leading and most well-known (meaning, best promoted) labs. Most were corrected after the labs were told to repeat the assays in certain ways. What would have happened if I didn’t know anything about analyses of natural products? Chances are that the wrong results would be used to make formulation and production decisions or supplied to customers who in turn would make these decisions to produce products that are not what they were intended to be.
Here is a recent experience I had with outside labs, just to show how unreliable the assays of even a common botanical can be. I was recently involved in the production of kava powdered extract, standardized to 30% kavalactones. The carriers for the powdered extract were maltodextrins and gum arabic. We traced the contents of kavalactones through the various stages of extraction by quantitative thin-layer chromatography (TLC), with results that varied by no more than 5%. When we sent the powdered extract (with 30% kavalactones) to independent labs for verification, results from 2 major labs showed only 12-15% kavalactones, much lower than the expected amount. I knew the results were wrong. When I talked to the analysts, I found out that in performing the assays, they simply dissolved the powdered extract with methanol and analyzed the resulting solution with high-performance liquid chromatography (HPLC). Obviously, the methanol was not able to completely extract the kavalactones (resinous material) from the powdered extract because they are bound (entrapped) by the carrier matrix. A prolonged 24-hour contact with methanol did better, but still only increased the assay results to about 25%, not the 30% expected. To make a long story short, I had to devise a simple sample-preparation method that involves first dissolving the carrier matrix with water to set free the resinous kavalactones, which are then extracted with ethyl acetate. The ethyl acetate solution can now be analyzed by HPLC or TLC, without the discrepancies in results as described above. This all goes to show that fancy equipment is useless unless run by analysts who know how to deal with natural materials. This incident only explains one source of error in analyzing kava extracts. Still unexplained is how one major independent lab could report 52.1% and 56.2% for the same extract (containing no carriers) that contained 51-52% kavalactones.
If you send samples of the same herbal extract to 2 different analytical labs, there is a good chance you will obtain widely different results. I think the reason that we have such low-quality services from independent labs is that after the Dietary Supplement Health and Education Act (DSHEA) was passed in 1994, these labs did such a good job in promoting themselves that they suddenly become the only game in town. They have so much business and are so busy that they have not had time to adequately test their assay procedures before doing tests for clients; hence they are actually not ready to do a good job, yet ready to charge exorbitant prices. The self-defense for manufacturers and suppliers is to set up their own testing. You don’t have to have expensive and fancy equipment to do a good job. You just need to have a capable phytochemist or pharmacognosist, not just any “Ph.D. chemist.” And unless you are into research on isolation and characterization of single chemicals from plants, all you need is TLC and HPLC instrumentation. If you do only 10 to 15 samples per month, at the rate you are paying these independent labs, you will recoup your investment within 18 to 24 months.
Early records of Chinese herbal anesthetics date back 1,800 years. They include formulas that were attributed to the famous Chinese physician and surgeon, Hua Tuo, who lived from around 141 AD to 208 AD. Legend has it that, because of his unmatched skills (especially acupuncture and surgery), he was sought after by royalty. However, he avoided such court positions due to his devotion to the masses, who he believed needed more of his skills than the privileged few. When the notorious Prime Minister of the Han Kingdom, Cao Cao, summoned him to treat his recurrent headache, he promptly relieved Cao Cao’s headache with acupuncture. Cao Cao then wanted to keep him as his personal physician. But Hua Tuo excused himself and went home; he never went back to Cao Cao. This angered the wicked Prime Minister who had him killed.
Although most or all Hua Tuo’s works have been physically lost, many of the herbal prescriptions attributed to him have survived in the writings of his disciples and later physicians. These include one of the famous anesthetic formulas attributed to him, called ma fei san, which has been widely mentioned over the centuries. No one seems to know its exact formula. But it is reputed to contain the following herbs: danggui (Chinese angelica root), yanzhizhu (Rhododendron molle fruit), moligen (Jasminum sambac root), and changpu (Acorus gramineus rhizome), all of which have analgesic properties. Other herbs that have long been used traditionally as analgesics or anesthetics include: clove, Sichuan peppercorn (Zanthoxylon bungeanum fruit), aconite root (Aconitum carmichaeli), tianma (Gastrodia elata rhizome), wuzhuyu (Evodia rutaecarpa unripe fruit), xixin (Asarum spp. – whole herb with root), nanteng (Piper spp. – twigs and leaves), liuzhi (Salix babylonica twigs), duhuo (Angelica pubescens – root and rhizome), opium poppy (Papaver somniferum – various parts), jianghuang (turmeric), xuchangqing (Cynanchum paniculatum – whole herb with root), and chansu (toad excretions).
Herbal anesthesia for tooth extraction [Sichuan Zhongyi, 15(12): 52(1997)]. This is a report from the the Zunyi Municipal Hospital of Stomatology, Guizhou Province. Patients’ ages ranged from 6 to 83 years, all with 2nd- and 3rd-degree loose teeth (according to a Chinese classification). Among the 736 teeth extracted, there were 263 deciduous front teeth, 196 deciduous molars, 182 permanent front teeth, and 95 permanent molars. As control, 250 teeth were extracted using dicain as local anesthetic.
Method: Grind the following into a fine powder – chansu 6 g, xixin 10 g, Sichuan peppercorn 10 g, caowu (Aconitum root) 5 g, borneol 9 g, and bohe (mint) 9 g. Place the powder in 100ml 95% alcohol and let soak for 3 days. After filtering off the residue the extract is ready for use. Perform routine pre-extraction procedures, including rinsing with boric acid antiseptic solution. Dry the area to be anesthetized and apply a cotton swab soaked with the herbal anesthetic. Wait a minute or two and then, using a dental instrument for separating gums, push the cotton swab towards the root of the tooth so as to allow the liquid to reach the gingival sulcus and the separated gum, which is easily separated in 2nd-and 3rd-degree loose teeth. Extract the tooth after 2 minutes.
Results: Among the 736 teeth extracted with the above herbal anesthetic, 702 were painless, while slight pain was felt in 34 (4.6%); the latter were mostly deciduous (milk) teeth. These results were no different than those of the dicain controls. In addition, there were no postoperative complications, nor general adverse effects. This was probably due to the minute amounts of strong herbs in the formula required for anesthesia.
This formula contains 2 very toxic drugs, chansu (toad excretions) and aconite. The former contains bufotoxins, while the latter contains aconitine and related alkaloids. Both types of compounds are highly toxic. For this reason, these 2 Chinese drugs are always used with extreme caution and often undergo special treatments or processing before being dispensed. They are definitely not for amateurs or those who think that if a little is effective, a lot must be much better.
Yu ping feng formula. Literally translated as “jade screen formula,” it first appeared in Dan Xi Xin Fa (Dan Xi’s Prescriptions) by Zhu Dan Xi (aka Zhu Zhen Heng), who lived from 1281 to 1358 AD in the Yuan Dynasty. This formula was originally prescribed as a powder, but is now also dispensed as tea bags, instant drinks, tablets, capsules, and other forms. The formula is quite simple, consisting of only 3 herbs in powdered form: 2 parts huangqi (Astragalus root), 2 parts baizhu (Atractylodes macrocephala rhizome), and 1 part fangfeng (Saposhnikovia divaricata root; siler). Although the total daily dose at times can be up to 27 g, it is customarily taken 2 times a day, 6-9 g each time, with warm boiled water. For maximum benefits, it can be taken with a soup prepared from dazao (common jujube). Alternatively, this formula can be taken as a decoction which is prepared by first soaking the herbal mixture (18-27 g) in 500-700 ml of cold water for 20 min, followed by boiling for 20-30 min. The liquid is decanted off and the marc is further decocted with 300-400 ml water. The 2 liquids are combined and taken half in the morning and half at night.
The major functions of this formula include the following: yiqi – benefiting or invigorating the qi (vital energy); gubiao – strengthening or firming up the “exterior” or “surface” to prevent infections; zhihan – stopping unnatural perspiration that is usually due to a weakened body system; and yufengxie – preventing attack by “evil wind” (exterior factors that cause illnesses; pathogens). The yu ping feng formula is one of the so-called fuzheng guben (strengthening-body-defense) tonic formulas used in TCM. It is traditionally used for people who are prone to catching colds, those who are weak and pale and perspire spontaneously without exercise, and those who lack energy and are always tired.
Modern findings have shown that the yu ping feng formula has immunoregulatory activities, which partly explains the rationale behind its traditional use in preventing the common cold and in strengthening the body of individuals who have been weakened by outside “evil-wind” such as pathogens and stress (including surgical), both of which compromise one’s immune system.2-4 Two of the component herbs, huangqi and baizhu, are well-known qi tonics that traditionally are considered to have body-strengthening effects. They are commonly used in tonic formulas. The third component in the formula, fangfeng, is also called ping feng or “screen,” alluding to its ability to shut out disease-causing agents (“evil wind”). It is traditionally well known for its disease-preventive properties, and is used in many anti-infective formulas. All three are commonly used in traditional Chinese medicine and are readily available in Chinese herb shops in North America.
(2) C.C. Shang, “Yu Ping Feng Powder,” Jiating Yixue, (20): 28-29(1998); (3) H.T. Xin et al., “Research Progress in the Immunopharmacology of Yu Ping Feng Powder,” Zhongguo Zhongyao Zazhi, 23(8): 505-507(1998); (4) X. Chen et al., “Immunoregulatory Effects of Supplemental Yu Ping Feng Instant Drink in Surgical Patients,” Zhongguo Zhongyiyao Xinxi Zazhi, 5(7): 22, 23, 6(1998); Leung, A.Y. and S. Foster, Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd Ed., Wiley-Interscience, New York, 1996, pp. 50-53, 239-240. 529-530.