LEUNG'S
(CHINESE) HERB NEWS
Number 29
November/December 2000

Herbs in this issue:

Mume (smoked plum)

Psoralea

Yan hu suo (Corydalis yanhusuo)

 

A Note From Dr. Leung

 

Why so many herbal supplements (drugs) don’t work?

 

    One of the most common misconception about herbal supplements is that their labels will tell you what they are.  But the sad truth is that no one can tell how good or bad an herbal supplement is by what is written on its label.  Granted, you may have a better chance of obtaining a good product if it is from a large or well-known company, though there is no guarantee.  Just pick up any eleuthero (Siberian ginseng) product from a store or pharmacy, chances are its quality will leave much to be desired, no matter how well-known the manufacturer or how professional-looking the packaging is (Issue 27, p. 3).  There has been a lot of publicity and hype about using chemically standardized herbal extracts.  The idea is good because if an extract contains the same amount of active chemicals, no matter where the manufacturer buys it from, the resulting herbal supplement containing this standardized extract will be

 

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.


 

of consistently good quality.  But the key is “active chemicals.”  The problem is that only a very few herbs contain known active principles that represent the major effects of these herbs, and there are no uniform standards for selecting the chemicals to be quality controlled.  Consequently, chemical standardization is still controversial and often misleading, especially if used inappropriately or fraudulently (Issue 22, p. 1).

The most serious problem currently plaguing the natural medicines and herbal supplements field lies in the materials used in the products.  No matter how good a botanical ingredient’s reputation is, if it is not present in the product, the product won’t yield the expected benefits.  There are 2 paths through which a product supposedly containing an effective botanical ingredient (e.g., an extract) fails to include this ingredient:  (1) Failure to correctly identify the ingredient (extract) used in the formula or intentionally substituting it with another cheaper and inactive ingredient.  When this happens, the effects due to the intended herb will not be there, despite the fact that the name of this herb appears clearly on the label.  Instead, the product will produce effects (or no effect) due to the wrong ingredient, whatever these effects (no effect) may be.  (2) Improperly extracting the correctly identified herb, which results in the wrong ingredient (extract) being incorporated in the product.  Thus, in this case, although it may be the correct herb, the extract (ingredient) derived from it is wrong.  A typical example is a hexane extract instead of a water extract being used; the 2 are as different as night and day. 

         Who takes these paths?  Unfortunately, too many people, including the sincere ones who don’t have the technical know-how and the dishonest ones who don’t care about quality!  The greatest damage is done when these mistakes or failures are committed by the larger companies because the general public are under the assumption that large companies know what they are doing and hence expect high-quality and genuine products from them.  Unfortunately, this is not usually the case, because, without the appropriate know-how, manufacturers simply don’t know how to source the correct ingredients and produce truly quality products, no matter how “technical” their advanced-degreed staff, how sophisticated their equipment, and how strong their financial resources.  Furthermore, when this happens, not only worthless or potentially harmful products are widely and undeservedly distributed to the public, these major manufacturers may also be inadvertently supporting unethical suppliers who are supplying them with inferior or adulterated ingredients.  A glimpse of this scenario was given in the last issue of this Newsletter relating to eleuthero.  Hence, the truth is bigger is not necessarily better.  After my experience with the eleuthero products, I may also add that brand names don’t guarantee you a good product either.  Furthermore, a product labeled as containing standardized extracts won’t guarantee a good product either, especially if the “standardized extracts” are those of tonic herbs or others whose active principles are not yet well-defined .  This does not mean that big companies or brand-name lines don’t have good products.  They often do.  It’s just that not every single product from them is good, as I have found out with euthero.  Consequently, if you are going to buy herbal supplements, you can still start with brand names or well-known products.  But be prepared to switch brands if you don’t get the benefits you expect. 

 

Herbal Treatment of Vitiligo

        Vitiligo is a troublesome problem, especially when it affects one’s face.  There are no known causes, though a compromised immune system, stress, and excessive sun exposure are a few possible ones.  There is no known cure in conventional medicine, though there are treatments, such as that with psoralens and ultraviolet A light (called PUVA treatment).  However, with those “incurable” ugly white patches, most often the best thing one can do is to cover them up with skin-tone cosmetics.  This happened to me about 11 years ago.  After a particularly stressful work situation followed by a week under the sun in the Dominican Republic, I developed several white patches, from 1/3 to 1 inch in diameter, on my forehead which spread over half its area.  Hoping they would disappear spontaneously the same way they had appeared, I covered them with skin-tone make-up borrowed from my wife.  Several weeks passed but the ugly white patches seemed to be there to stay.  I started reading up on vitiligo and looking for a simple Chinese remedy that might work.  Frankly, I was skeptical in the beginning.  But after I started digging into the Chinese literature, it became clear to me that vitiligo has been around in China for ages and that there are many remedies for its treatment.  The remedies range from single herbs to typical multi-herb formulas containing up to a few dozen components.  Being naturally lazy, I picked one that is the simplest and also has some scientific basis – a tincture of psoralea fruit (Cullen corylifolium or Psoralea corylifolia).  It can be easily prepared by soaking the herb in gin (or another strong liquor) for a week to 10 days and one can use a cotton ball to apply it to affected areas.  Following application you need to go outdoors and soak up some sunlight.  The first few applications were fine.  Then after a week or two (I don’t remember precisely), after I applied the tincture followed by sun exposure, I had a rash, which eventually turned into itchy raised red patches with blistering.  Fortunately, I was forewarned by the literature and just stopped for a few days until the blisters subsided.  Then I applied the tincture again and got the same problem, and I stopped, probably after maybe 4 weeks of treatment.  Miraculously, when the rash subsided, my white patches were gone.  Now I had red and slightly inflamed skin for a few days, which eventually turned to the same color as my normal skin.  Although the large white patches have disappeared, up until now I still have 2 small patches (about 1/3 to inch in diameter) on my left forehead at the hairline, which are basically covered by my hair, so I need not do anything to them. 

        I recently came across another simple treatment of vitiligo which has been reported to yield very good results.1  The tincture can be easily prepared by soaking 100g of Japanese apricot fruit (also known as mume, wumei, and smoked plum; Prunus mume) in 1,000 mL of 75% alcohol for 10 days, followed by filtration.  For comparison, a tincture of psoralea was prepared in the same manner.  Over a 17-month period (February 1998 to July 1999), 117 patients were treated with the mume tincture and 91 treated with the psoralea tincture.  The patients’ ages ranged from 15 to 55 years (average 28.7); 110 females and 98 males.  Duration of illness ranged from 1.5 to 37 years (average 12).  For treatment, the tincture was applied topically twice daily, gently massaging the affected areas after each application.  When allergic reactions occurred, the skin lesions were allowed to resolve and then treatment resumed and continued for up to 8 months.  In the mume group, the shortest treatment was 15 days and the longest 8 months (average 3.28 months).  In the psoralea group, the shortest treatment was 1 month and the longest 8 months (average 3.40 months).  Among the 117 patients treated with mume tincture, 47 (40.18%) had complete repigmentation, 25 had over 50% response, 30 had less than 50% response and 15 had no response, with a total response rate of 87.18%.  In comparison, among the 91 patients treated with the psoralea tincture, 31 (34.07%) had complete response, 25 had over 50% response, 19 had less than 50% response, and 16 had no response, with a total response rate of 82.42%.  The difference was not statistically significant (P>0.05).  Contact dermatitis occurred in 2 patients of the mume group and in 5 of the psoralea group. 

        Overall, it appears that the mume tincture is as effective as the psoralea tincture in treating vitiligo.  The main advantage is that it is less allergenic.  The efficacy of psoralea tincture has a scientific basis, due its content of psoralens that are part of a modern conventional treatment.  But what is in mume that has this activity?  I have no idea, though the author postulates that the tyrosine present in mume may be used by skin cells to increase their synthesis of melanin.  So far, chemicals found in mume include mostly plant acids (citric, malic, oxalic, succinic and fumaric, with the first 2 predominant), triterpenes (e.g., oleanolic acid), sterols (e.g., b-sitosterol), flavonoids (quercetin-3-O-rhamnoside, kaempferol-3-O-rhamnoside, etc.), amino acids (e.g., tyrosine), volatile oils (with benzaldehyde predominant), picric acid, amygdalin, and superoxide dismutase (SOD).2,3  The fact that something in mume (containing no known psoralens) which appears to be effective against vitiligo, intrigues me.  I would have used it instead of the psoralea tincture were it known 11 years ago. 

(1) R. Run, “Treatment of 117 cases of vitiligo with wumei tincture,” Shiyong Zhongyiyao Zazhi, 16(8): 32(2000);  (2) Zheng, H.Z., et al., Zhongyao Xiandai Yanjiu Yu Yingyong (Modern Studies and Applications of Chinese Medicines), Vol. 2, Xue Yuan Press, Beijing, 1997, pp. 1198-1213; (3) Zhonghua Bencao Editorial Committee, State Administration of TCM, “Zhong Hua Ben Cao (Chinese Herbal),” Vol. 4, Shanghai Scientific and Technical Publications, Shanghai, 1999, pp. 86-90.

Leung, A.Y., and S. Foster, Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics, Wiley-Interscience, New York, 1995, pp. 541-542.

  

More on/from the “Complete Guide to Herbal Medicines” by 2 PharmD’s (Issue 28, p. 1)

        The more I scan this book the more I find it amazing that a book containing such large amounts of errors (major and minor), misinformation, illogical thinking, and plain ignorant statements could have sailed past the publisher’s editorial review board and gotten published!. 

        In this issue, I am not critiquing any particular herb entry.  Rather, I just want to point out some mistakes in the first 8 pages of the “Complete Guide” (containing 698 pages!!) that deal with the topic, “Understanding and Using Herbal Medicines.”  On page 1, under “Common drugs made from plants,” the first drug described is aspirin as from white willow bark and meadow sweet plant.  The fact: aspirin is the acetate of salicylic acid (or acetylsalicylic acid); it does not occur in those plants; only salicylic acid does.  The latter is used in the synthesis of aspirin.

        The next “minor” items are chan su and jin bu huan on page 2, listed under “Potentially dangerous herbs.”  I noticed them immediately because they are in Chinese pinyin, which is one of the 2 official systems of transliterating Chinese characters into English.  However, these English transliterations only tell part of the story, because each transliteration can represent several to many characters, depending on the tone of the Chinese word/character.  For example chan can have close to 2 dozen meanings (e.g., cicada, shovel, toad, give birth, murmur, greedy, slander, flatter, explain, weak, etc., etc.).  Consequently, if you are not familiar with Chinese medicine and not well versed in pinyin transliteration, you will have no idea what chan su is.  Since the authors have said in their Preface that they wrote the guide to “…give you the scientific facts about herbs – not to confuse or distract you with the myth and folklore that surround them…” they have the obligation to identify any “herb” that they describe in their book.  Telling us that chan su is “a topical aphrodisiac also known as stone, love stone, and rockhard,” certainly does not give us a “scientific fact.”  If they don’t know what chan su is, why list it.  As pharmacy professionals, would they dispense an analgesic if they didn’t know exactly what it was?  Of course not.  But why do they keep applying a different standard to herbs!?  As an illustration, borrowing their wording, how helpful would, “Pain-Away, a topical analgesic also known as pain-stop, pain-no-more, and relief, has caused cardiac shock when mistakenly ingested.” without identifying what analgesic(s) “Pain-Away” contains?  This is the kind of information that must be provided to make the book of any use.  Again, looking at the more-than-seventy technical consultants and contributors listed in the book, none appears to have any training and experience in herbs.  Without consulting herbal experts outside the “inbred” pharmacy and medical circles, how can they expect to produce an herbal book that contains accurate and unbiased information?  They are like the blind leading the blind

        If the authors had actually sought the advice of any traditional Chinese doctor or any expert in Chinese herbs, they would have found out the following: chan su is the dried venom (secretion from skin glands) of toads.  It has a recorded use history of at least 1,300 years in China.  Major uses include analgesic, antiinflammatory, cardiotonic, and detoxicant.  Its alcoholic extract also has local anesthetic effects and has been used in various local anesthetic preparations, frequently in combination with aconite and xixin (Asarum sp.), an example of which was described earlier (Issue 17, p. 3).  Like aconite, chan su is definitely toxic but no more so than aconite root and oleander leaf.  Yet the latter 2 are not listed under the “Potentially dangerous herbs.”  Compared to other herbs, the chances of any American using any of these herbs are minuscule, even though this fact does not lighten their toxicity if ingested.  The reason that chan su is used as an “aphrodisiac” is probably due to its local anesthetic effect (like lidocaine or procaine used in such products).  When used topically on the glans penis, an extract of chan su, aconite, or even the Chinese spice Sichuan peppercorn, would numb it so that it could remain erect for longer periods, hence the name rockhard, etc.  Without identifying what chan su is or contains, it may well be a formula containing synthetic local anesthetics or the herbal drug aconite as major components.  Nobody, even the authors, knows.   For those interested, the chemistry of chan su (containing bufotoxin, bufotalin, bufotenine, etc.) has been well documented and can easily be retrieved from the chemical literature by using Bufo spp. and toad as key search words.  .

        Next is jin bu huan, which loosely means “cannot be replaced by gold,” better than gold,” or simply “highly valuable.”  A quick check in the 11-volume Zhongyi Fangji Da Cidian (Encyclopedia of TCM Formulas) which documents more than 130,000 formulas over the past 2,000 years, reveals 16 different formulas under the name jin bu huan.  They are mostly derived from classic formularies published since the middle of the 13th century and are quite different in their properties, uses, and methods of application.  It is NOT “an ancient Chinese sedative and analgesic, contains morphine-like substances and has caused hepatitis” as described by the authors.  Among the 16 prescriptions, only 2 (from the 13th and 14th centuries) are listed to contain dried opium poppy capsules along with bai-zhu atractylodes, kuan dong hua (coltsfoot flower), tangerine peel and huan lian (Coptis) in one and cured xing ren (apricot pit), licorice root, and zhi qiao (nearly mature fruit of bitter orange) in the other.  Opium capsules are listed as the main herb in both formulas.  The primary indication of both formulas is for cough.  Even though both prescriptions contain morphine-like substances, it is highly doubtful the “Complete Guide” authors had them in mind when they listed jin bu huan.  More likely, what they refer to as jin bu huan is a modern drug formula containing tetrahydropalmatine (also found in opium but is usually isolated from yan hu suo (Corydalis yanhusuo tuber).  Such a formula is hardly “an ancient” Chinese formula.  Again, without clearly identifying what jin bu huan is, the authors are not giving us a “scientific fact” but rather a hear-say mystery. 

        Then, there is also this listing, “Indian herbal tonics can lead to lead poisoning.”  How can such a statement be made at all, especially by supposedly professionals trained to be nonbiased in disseminating information?  How many Indian tonics have the authors evaluated and what percentage is loaded with lead?  I am sure they won’t publish statements like “Synthetic analgesics can lead to kidney damage” or “Synthetic analgesics can lead to heart failure” even though these 2 statements have as much truth or falsehood (depending on how one views it) as the first. 

        Immediately following the “Potentially dangerous herbs” list, the authors state, “Some herbs and plants have value not just for their active ingredients but for other substances they contain, such as:

          minerals

          vitamins

          volatile oils (used in aromatherapy)

          glycosides (sugar derivatives)

          alkaloids (bitter organic bases containing nitrogen)

          bioflavonoids (colorless substances that help maintain collagen and blood vessels).

 

        Such profound statements!  What were they thinking of when they wrote the above?  What are “active ingredients” by their definition?  Do they mean none of the above compounds are biologically active?  The fact is that many of the above classes of compounds have strong pharmacological effects, especially the last 4 categories – volatile oil components (eugenol, methylsalicylate, thymol, eucalyptol, etc.); glycosides (ginsenosides, aloins, cascarosides, sennosides, rutin, glycyrrhizin, etc.); alkaloids (caffeine, cocaine, morphine, codeine, berberine, ephedrine, etc.); and bioflavonoids (countless, like those in ginkgo, licorice, hawthorn, green tea, etc.).  Also, where did they obtain their information to say that bioflavonoids are colorless substances?  In fact, many are colored like rutin (a yellow flavonoid glycoside), which appears to be the one they had in mind [“help maintain collagen(?) and blood vessels] when they wrote the above description.  But of course, as typical of this “Complete Guide” you can’t be sure of what they mean, because they are not sure themselves. 

        On page 8, under “Tinctures and extracts” the authors again show their ignorance regarding a major aspect of herbal medicine.  There they write, “An herb placed in alcohol or liquid glycerin (to distinguish it from solid glycerin?) is called a tincture or an extract.  (Tinctures contain more alcohol than extracts.)  Alcohol draws out the herb’s active properties, concentrating them and helping to preserve them.  Alcohol is cheap, is easily absorbed by the body, and allows the herb’s full taste to come through.  Alcohol-based tinctures and extracts have an indefinite shelf life…...”  The first sentence is a typical example of muddy and illogical thinking and ignorance (see also Issue 17, p. 1 for another such example).  By this definition, a piece of dandelion root in my hand is “dandelion root,” but after I have placed it in alcohol or glycerin, this same piece of herb now becomes either “dandelion root tincture” or “dandelion root extract!”  And tinctures are NOT distinguished from extracts by the amount of alcohol!  Here is the technical truth: a tincture is simply 1 type of extract, and there are numerous types, including fluidextract, solid (pillular) extract, powdered extract, and native extract.  Extracts can be prepared by using various solvents (or menstrua) including alcohol, aqueous alcohol, water, and glycerin, and they can be any strength from weak (e.g., infusion) to highly concentrated (native extract).  Tinctures, specifically, are alcoholic or hydro-alcoholic extracts containing normally 10% and sometimes 20% of the crude herbs equivalence, which means 10g or 20g of herb are used to make 100mL of the finished tincture. 

Leung, A.Y., and S. Foster, Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics, Wiley-Interscience, New York, 1995, pp. xxxii-xxxv.