(CHINESE) HERB NEWS
Herbs in this issue:
A Note From Dr. Leung
Scientific studies/reports – what are we studying/reporting?
There is a whole new field of modern scientific endeavor that is stuck in an intellectual twilight zone. I am referring to the research in herbs as applied to modern health care. Unlike research in other areas, such as drugs and chemicals, research in herbs has a unique difference. This difference lies in the fact that herb research lacks a uniform set of criteria for evaluating its research materials. Researchers investigating herbs frequently have no idea of what they are studying. They have heard about ginseng, so they study “ginseng.” Or they find herb XYZ fascinating, so they study what is purported to be XYZ, without actually having any idea of what that XYZ is. Many published research and clinical studies on herbs are based on this approach. It appears to me that medical and pharmaceutical researchers frequently are so proud of their scientific protocol and yet pay so little attention to the test materials when these relate to natural products. Thus, if a pharmaceutical or medical scientist undertakes to study acetylsalicylic acid (aspirin) and you supply
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.
him with acetaminophen as the chemical to be studied, he will immediately notice your error. But if the same researcher were studying “ginseng,” you could supply him with any of several different herbs known as “ginseng,” and chances are he would not question you at all. This is analogous to an ignorant researcher doing a study on an “analgesic” without specifying the type of analgesic. Hence, over the past couple of decades, we have been rapidly accumulating published research data on herbs, much of which is largely meaningless. So what do we do? We keep disseminating these data as if they were valid. I believe there are 2 main reasons: (1) these data fit our bias; and (2) many of us can’t tell the difference between meaningful and meaningless herb research data. Thus, the most infamous publication immediately comes to mind, which is the so-called “ginseng abuse syndrome” article (Issue 17, pp. 1-2).1 To this day, it is still being quoted by some researchers and writers who are obviously quite knowledgeable in their own fields, though not in herb research! I simply can’t understand how anybody can draw conclusions from studies on “ginseng” that could be any herb with the word “ginseng “ attached to its name, as well as any adulterated product bearing the name “ginseng” on its label, which in those days, could be sawdust! Is that science? Or is it simply preconceived bias against herbs? Maybe it is simply ignorance. I wish I had time to go over some of the original papers that have now been quoted as authority for either pros or cons for numerous herbs. I’ll bet many of the materials studied, with results already published, have not been correctly identified or specified. In any event, the following are 3 recent publications from 3 different countries (I don’t want to pick on any one country), 2 of which were forwarded to me by an esteemed colleague. These are, sadly, typical of the kind of research that is being carried out on herbs whose results continue to be widely disseminated by non-discriminating writers and the gullible popular press (also see Issue 17, p. 1).
(1) (1) “Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections,” published in Complementary Therapies in Medicine, 1997, Vol. 3, pp. 40-42. The trial was performed by German and British scientists, which demonstrated a highly significant effect of Echinaceae pallidae radix over placebo in reducing the length of the illness. This sounds great. But I have a problem with it. There is no clear indication in the paper as to what kind of extract was used. In the introduction, it says “a liquid form of Echinaceae pallidae radix extract.” Then nowhere else does it describe the extract they used. An alcoholic extract is quite different from an aqueous extract; and, depending on the percentage of alcohol present, aqueous alcoholic extracts are not all the same. The authors seem to have left a clue under METHODS, as they describe the placebo as “a coloured aqueous alcoholic solution that mimicked and was indistinguishable from the real treatment.” But under RESULTS, they refer to “..900 mg Echinaceae pallidae radix (per day)…” Chances are they mean an amount of extract that represents 900 mg of the crude herb. And based on the other “clues” left by the researchers, they most likely mean an “aqueous alcoholic extract of Echinacea pallida root.” However, this is supposed to be a scientific publication, which should be precise; and we are not supposed to guess what the authors mean. Besides, even an aqueous alcoholic extract is not clearly defined enough. For example, does it contain 25% alcohol or 75% alcohol? The 2 solvent systems extract quite different active components from the same herb that contains polysaccharides, alkylamides, ketoalkenes, ketoalkynes, essential oils, polyphenols, etc. Science has to be precise, otherwise it is not science. I was once “accused” by a co-author of being too picky when it comes to reporting research data. But to me, sloppy research (or reporting) only perpetuates the continued dissemination of misinformation or meaningless information. And if you quote this paper without finding out what precisely the researchers used in their clinical trial, you will be guilty of disseminating misinformation.
(2) (2) “Ginseng Therapy in Non-Insulin-Dependent Diabetic Patients,” published in Diabetes Care, 1995, Vol. 18, No. 10, pp. 1373-1375. Here is another one of those publications probably already being widely quoted by ginseng proponents as support for “ginseng’s” beneficial effects that include elevating mood, improving psychophysical performance, reducing fasting blood glucose and body weight, etc. The study was undertaken by Finnish scientists. However, this paper has a flaw. The authors do not specify what type of ginseng they used, other than simply identifying the material as “ginseng” tablets (quotes are mine) from a Copenhagen drug company. There is no indication whether the material being studied was American or Asian ginseng, and for that matter, a Panax material at all. Nor is there any indication whether the “ginseng” used was an extract or crude root powder. I am sure the researchers took great pains in designing and following standard medical research protocol (with randomization, double-blinding, and placebos, etc.). But what good is your research or publication when you don’t even know or specify what you are investigating or reporting on? Unless further identified and specified, “ginseng” can be anything, I mean, anything. In its present form, this paper is meaningless and useless to other scientists unless the nature of the “ginseng” tablets is clearly identified.
(3) (3) “Anti-epileptic Effect of Ciwujia (Eleuthero or Siberian Ginseng),” published in Hebei Zhongyi, 1998, Vol. 20, No. 5, p. 269. This paper reports the treatment of 45 children with primary epilepsy, using ciwujia tablets or drink, with remarkable results. However, no characterization of the “ciwujia” was given. Again, the Chinese doctors, like their Western counterparts above, treat the test material (ciwujia) as if it were a pure chemical drug that can be readily identified by name alone. They don’t give any clue as to what kind of eleuthero (crude herb, alcohol extract, water extract, or hexane extract?) they used. As far as I am concerned, they could be using Periploca sepium Bunge, any of several other Eleutherococcus spp., or anything the local people call “ciwujia.” I am not as concerned about herbs in typical traditional Chinese herbal formulas for the following reason: Even though there may be an occasional substitution of one or two herbs in these formulas that often contain up to 2 to 3 dozen herbs, the damage to the formulas will only be partial. In contrast, with single-herb usage (rare in traditional practice anyway), any wrong substitution constitutes one hundred percent damage. Fortunately, in the present case, since the article is in Chinese, its chances of contributing to the misinformation data pool outside of China are slim. And I will try my best to make sure it does not get there.
In addition to the above 3 papers, here are 2 abstracts that are totally meaningless for citation purposes. These were provided to me by a colleague who in turn obtained them through NAPRALERT (a natural products database). Whether these are NAPRALERT’s own abstracts or from one of the major abstract services is not clear.
(1) (1) “Echinacea-associated anaphylaxis,” published in Med. J. of Australia, 1998, Vol. 168, pp. 170-171. This abstract gives no indication as to which species of Echinacea and what types of extracts or preparations were being used. So this basically would cover any commercial product called “echinacea,” which is, of course, of little utility to anyone other than marketers.
(2) (2) “Cytokine production in leucocyte cultures during therapy with echinacea extract (Echinacea angustifolia Compositae),” published in J. Clin. Lab. Anal., 1996, Vol. 106, pp. 441-445. The abstract gives a dose of 3.0 ml/day, but no information of the type of extract the researchers used. Thus, for example, was it a water extract, alcohol extract, aqueous alcoholic extract, or even an alcohol solution of the residue of a hexane or acetone extract? Without the above information, this kind of abstract is useless. But the problem is that people are going to cite it and the misinformation will pass through the database mill to add to the already cluttered and contaminated information network.
The only way to avoid meaningless abstracts like the above entering the scientific and medical databases of the world is to require abstractors to follow a set of abstracting guidelines (in addition to existing ones) that specify criteria for reporting or evaluating herbal materials used by authors/researchers. Minimal information should include plant species (Latin binomials), part(s) used, product form (powdered crude herb, aqueous extract, ethanol extract, aqueous alcohol extract with specific proportions of water to alcohol, specifically extracted fractions, etc.), and clearly expressed quantities or concentrations. Such information, whether included or missing in an abstract, would allow fellow researchers and readers to decide whether the abstract in question is useful and worth citing. To help them to conduct research and/or report findings that will be meaningful, we need to provide them with guidelines on which to set minimal standards for accepting or rejecting test materials as well as manuscripts for publication. Here is what I propose to do. There are enough credible scientists out there who are knowledgeable about herbs; some also have insight into how traditional herbal medicine works. They can establish a set of criteria for characterizing research materials in their various forms and then present it to those of the scientific community who intend to study herbs. These criteria can provide guidelines for scientists doing research on herbal materials or for journal editors or reviewers to evaluate submitted papers. If the research subject materials do not meet certain criteria, they should be rejected. Or if a submitted paper contains herbal materials as subject of the research, which do not meet minimal criteria set forth in the criteria, the paper should be rejected for publication. Once we have this uniform set of criteria for accepting botanical materials for research, we will eliminate a major part of our current problems. This will also save the world a lot of resources wasted in transporting meaningless research data back and forth, in trying to settle arguments when none should have been started in the first place, and in correcting misinformation or debunking meaningless research.
(1) R.K. Siegel, “Ginseng abuse syndrome,” JAMA, 241, 1614-1615(1979).
“Listen” to Your Body
It is a fact that some people are just plain tougher than others and there is nothing we can do to change that. However, with whatever we have, we can stand a better chance of keeping our good health by “listening” to our body. If we haven’t abused it, it is generally quite resilient. And oftentimes it has the ability to heal itself, without any modern medical intervention, when we happen to become ill.
There is no monopoly in the attainment of good health. You can be healthy by following strictly modern conventional medical and nutritional teachings, taking the most advanced medicines and other interventions whenever you are ill. You can also be healthy by following good old traditional common sense and by “listening” to your body, without relying on conventional medicines. Then, of course, you can also be healthy by picking the best out of the two. I follow mostly the last route. I consider myself healthy and full of energy, and I take pride in having more energy and endurance than colleagues and friends 30 years younger than I. I don’t take any modern drugs and I probably took my last anti-histamine for my hay fever at least 10 years ago. Also, I don’t remember when I last took a prescription drug. On the other hand, I take a one-a-day vitamin and 1 or 2 of my own Chinese herbal tonic formulas. I have been doing this for over 10 years, long before the current rush for nutritional and herbal marketers to capitalize on the weakness of DSHEA and the gullibility of consumers. Have the vitamins and my Chinese tonics been keeping me healthy? I think so. But I don’t have any “clinical proof.” Or is it perhaps because I have been “listening to my body” all these years? Over the years I have been keeping an alert “ear” to what happens to my body and taking mental notes and adding on to my “listening” skills. The most recent has to do with exercise.
I am basically a lazy person when it comes to doing exercise, despite my awareness of the traditional wisdom and modern findings regarding exercise. I had always been healthy and active; hence there was little incentive for me to exercise regularly other than an occasional hike. Then our daughter adopted a very active dog (golden retriever and Chesapeake mix) from the animal shelter last June and I was the designated walker as I had been to other dogs before this. Unlike the previous ones with which I usually strolled, this one demands more action. So I started fast-walking him every day for about 30 minutes whenever I was home. After the first couple of weeks of this fairly rigorous exercise, I started to feel better than ever and I seemed to yearn for the exercise. When I am traveling, I use the treadmill at hotel exercise rooms. To make a long story short, I had a very unusual experience at my dentist’s during my last semi-yearly teeth cleaning. Usually, it would take the dental hygienist about forty-five minutes to finish the job. Then, my dentist would appear and scrape some more. He would also poke at my gums to look for pockets and sometimes would declare to the dental hygienist the numbers 4 and 5 and even, once in a while, a 7. The whole appointment would normally last an hour. But this time, a new hygienist worked on me. The first thing I noticed was that she barely scraped my teeth, and there was practically no blood at all. I was telling myself that she probably didn’t know what she was doing and just “wait till my dentist appears!” I expected him to do a major cleaning and was cringing for it. But I was amazed that he also barely scraped my teeth, uttering numbers no higher than 3 when poking at my gums, and I was out of his office in half-an-hour! In all the years I went to him, this was the first time my teeth needed hardly any cleaning! When I tried to figure out why my teeth were in such great shape this time, the only thing I could think of that I did differently than before was that I had added regular exercise to my daily routine. I had been doing that for about 5 months before my dental appointment. Could moderate exercise benefit teeth and gums? Probably. Now I can’t wait till my next teeth cleaning! And that is a first! I will keep you posted, one way or the other. Regular sensible exercise has been demonstrated to benefit the immune system, mental health, and other body functions. Why not the oral cavity? In any case, I am sold! My body tells me moderate exercise makes it happier, and I listen to it, whether or not my teeth and gums have actually improved.
Herbal Formulas for Drunkenness and Hangover
Traditional Chinese herbal records describe over 40 herbs/foods that have been used for treating alcohol intoxication. Many of these have already been described earlier in this Newsletter (Issue 3, p. 3; Issue 9, p. 3), the most commonly used ones are kudzu flower, kudzu root, and zhi ju zi (Hovenia dulcis or raisin tree seed). Here are a few more formulas taken from classic herbals or formularies as recently reported in a Chinese TCM journal:2 (1) Formula to prevent getting drunk – Decoct (boil) 30 g each of bai zi ren (Platycladus orientalis seed) and da ma ren (Cannabis sativa or hemp fruit) and drink the liquid. It is said to increase one’s alcohol intake threefold. (2) Formula to awaken the drunk – Decoct 130 g of gypsum and 90 g each of kudzu root and fresh ginger, and feed the liquid to the drunken person. Incidentally, for those who have not heard of the word “decoction,” it is the preparation of an herbal drink by the following general process: Place the herbs in an earthen pot (porcelain ware will do). Put enough cold water to cover the herb and then some. Let sit for 20 to 30 minutes. Then bring to a boil and let simmer for 30-40 minutes until the liquid is boiled down to maybe two-fifths or one-third. Decant off the liquid. Add more water to cover the remaining herb (called marc). Again boil and let simmer for 20 to 30 minutes. Combine the 2 liquids. The resulting liquid (also the procedure) is called decoction. Some herbs (e.g., tonics) require a longer simmer while others (e.g., aromatic herbs for treating colds and flu) are only briefly boiled. Normally, one starts with cold water, and not hot water. The scientific rationale is that boiling water may denature proteins or fix other constituents within the plant tissues, trapping certain active compounds, thus making them unextractable.
The following 3 formulas were tested on white mice: (A) Gypsum decoction (drink) – is a modification of the last formula, with a gypsum:kudzu root:dried ginger ratio of 6:5:3; (B) Qian zhong jiu – is a classic formula consisting of zhi ju zi, sha ren (fruit of Amomum villosum or A. xanthioides) and dried ginger in a 10:1:2 ratio; (C) Jie jiu fang (alcohol detox formula) – consists of equal amounts of zhi ju zi and kudzu root. White mice were fed a predetermined amount of white liquor, via stomach tube, which caused them to lose their righting reflex (unable to turn themselves back up, in other words, stoned). They were then fed decoctions of above formulas to see how fast they could turn over again. Compared to control mice fed a saline solution, the recovery time (return of the righting reflex) was shorter in mice treated with formulas A, B, and C by 20.9%, 15.5%, and 25.4%, respectively.3
(2) W.S. Sun et al., “Research Status on Alcohol-Detoxification Formulas,” Gansu Zhongyi, 11(3): 47-48(1998); (3) Z.Y. Luo, “Experimental Study on Alcohol-Detoxification Formulas,” Zhongyao Tongbao, 13(4): 28-30(1988);