A review of the potential forensic significance of traditional herbal medicines.

Dr.Steve’s BOTTOM LINE: Prevention of cancer rather than suffering, treatment side effects, misery and death is THE goal as we move into the future.  For the past 20 years or so researchers and big pharma have begun to appreciate this and various pharmaceuticals have been tested in clinical trials.  The most memorable were Tamoxifen and Raloxifene to prevent breast cancer.  There are many other examples as we being to understand the exact biochemical pathways which cause each type of cancer.  In most cases, these prevention drugs target ONE biochemical pathway at at time.  This is perhaps the purest scientific way to find out what works but, as we find out what pathways exist, attacking or interrupting them at multiple points at a time seems like a better idea.  Enter the herbs of Traditional Chinese Medicine (TCM).  They have been reputed to prevent cancer for eons.  Do they work and why?

A recently published review looked at how TCM herbs might work. Lo and behold they target pathways that some pharma drugs target, and more than one at a time! These include pathways that prevent cancer cell growth, invasion and metastasis by modulating a wide range of molecular targets, including cyclooxygenase-2 (COX-2), nuclear factor-Kappa B (NF- B) and nuclear factor erythroid 2 -related factor 2 (Nrf2)-mediated antioxidant signaling pathways. This all  sounds like a lot of medical gobbledeegook, but suffice it to say that this is a VERY promising result which strongly suggests that the TCM herbal claims of cancer prevention are plausible and backed by scientific proof. We still have a long way to go to determine exactly which active components of various herbs affect what pathways. However,  this will lead to a non-toxic  alternative to drug-based prevention, done naturally!

Molecular Basis of Traditional Chinese Medicine in Cancer Chemoprevention.

Curr Drug Discov Technol. 2010 Mar 15;

Authors: Wang S, Penchala S, Prabhu S, Wang J, Huang Y

Cancer is the second leading cause of death, for which current therapeutic approaches are still very limited. Chemoprevention is an important approach to decrease cancer morbidity and mortality by the use of non-toxic natural or synthetic substances to reverse the processes of initiation and subsequent development of cancer. A substantial amount of evidence from human, animal and cell line studies has shown that many herbal products used for traditional Chinese medicine (TCM) can exert chemopreventive effects. The underlying theory for TCM to treat or prevent cancer is to bring the patient back to a healthy state by modifying multiple cancer-causing events. Since carcinogenesis involves multiple abnormal genes/pathways, using TCM in cancer chemoprevention may be superior to the agents targeting a single molecular target alone. However, before TCM can be accepted universally as complementary and alternative medicine for cancer treatment and prevention, it is crucial to understand the molecular basis for their effects. This review highlights several known molecular mechanisms of selected TCM in chemoprevention. Many TCM products or single active components have been reported to inhibit a variety of processes in cancer cell growth, invasion and metastasis by modulating a wide range of molecular targets, including cyclooxygenase-2 (COX-2), nuclear factor-Kappa B (NF- B) and nuclear factor erythroid 2 -related factor 2 (Nrf2)-mediated antioxidant signaling pathways. The TCM and their active components with potent chemopreventive effects can be considered as promising lead agents for the design of more effective and less toxic agents for cancer chemoprevention.

PMID: 20226002 [PubMed - as supplied by publisher]

Technorati Tags: alternative cures, chemoprevention, chinese herbs, herbal cancer prevention, natural cures

Dr.Steve’s BOTTOM LINE: In order to find out if acupuncture, or any other treatment, works for high blood pressure a randomized clinical trial needs to be done. This means, comparing one treatment to another (i.e. in this case real vs. sham acupuncture) where the treatment is randomly selected (i.e. a flip of the coin to determine which treatment you get).  Fortunately, there have been some. Unfortunately, not many and of variable quality.  Simply publishing a “report” that something “works” is not highly scientific and can lead to the wrong answer…..often.  So, when taken as a group what do these randomized trials say about acupuncture for treatment of high blood pressure?

This is a published report of all randomized trials out there, analyzed and grouped as a meta-analysis.  This means, the scientific strength of each study was examined and then the statistical numbers were all compared as a group rather than having the interested reader  look at all of these studies individually.  This way you don’t have to pull your hair out trying to figure out which one(s) to believe.

The bottom line is that when the higher quality studies looked at defining the reason for high blood pressure, and essential hypertension (the most common type) was looked at separately from other types of blood pressure elevation,  acupuncture clearly helped reduce blood pressure (both systolic and diastolic).  Of note, patient groups receiving sham (fake) acupuncture and real acupuncture  both were also on medications.  Unfortunately, out of the group of some 20 studies, only three were of high quality and helped get to this conclusion.  More studies are definitely needed, but this is a step in the right direction to determine how much acupuncture really helps.

Acupuncture for essential hypertension.

Altern Ther Health Med. 2010 Mar-Apr;16(2):18-29

Authors: Kim LW, Zhu J

OBJECTIVE: To assess the efficacy of acupuncture for treatment of essential hypertension and the efficacy of acupuncture using prescription adhering to the principles of “syndrome differentiation.” DATA SOURCES: Medline, Embase, Cochrane Central Register, and China National Knowledge Infrastructure (September 2008). STUDY SELECTION: Randomized, controlled trials comparing acupuncture with sham acupuncture, antihypertensive drugs, Chinese herbal medicine, or exercise in essential hypertension. DATA EXTRACTION: Two reviewers independently assessed trials for inclusion, extracted data, assessed methodological quality, and extracted outcome data on blood pressure. DATA SYNTHESIS: Treatment effects were summarized as mean differences with 95% confidence intervals. Twenty trials were included: three trials were relatively rigorous while others were methodologically suboptimal. Acupuncture arms achieved significant effect modification on blood pressure compared with control arms (19 comparisons: systolic blood pressure [SBP]: mean difference -4.23 mmHg, 95% confidence intervals -6.47 to -1.99; diastolic blood pressure [DBP]: -2.53, -3.99 to -1.08), with significant heterogeneity. In high-quality trials, blood pressure was significantly lower in treatments of acupuncture plus antihypertensive drug arms than in sham-acupuncture plus hypertensive drug arms (two comparisons: SBP: -5.72 mmHg, -8.77 to -2.68; DBP: -2.80, -5.07 to -0.54), with no significant heterogeneity. As for trials using prescription adhering to the principles of syndrome differentiation, we found a significant blood pressure reduction with acupuncture arms in comparison with control arms (11 comparisons: SBP: -6.46 mmHg, -8.04 to -4.87; DBP: -3.07, -4.17 to -1.96) with no significant heterogeneity. In contrast, in trials not using prescription adhering to the principles of syndrome differentiation, we found no significant reduction in blood pressure with acupuncture arms in comparison with control arms (eight comparisons: SBP: -1.55 mmHg, -5.39 to 2.29; DBP: -2.12, -4.97 to 0.73) with significant heterogeneity. CONCLUSIONS: Because of the paucity of rigorous trials and the mixed results, these findings result in limited conclusions. More rigorously designed and powered studies are needed.

PMID: 20232615 [PubMed - in process]

Technorati Tags: alternative cures, chinese herbs, natural cures

Dr.Steve’s BOTTOM LINE: Juzentaihoto is a mixture of Rehmannia root, Astragalus root, Cinnamon bark, Peony root, Atractylodes rhizome, Cnidium rhizome , Angelica root, Ginseng, Hoelen, some Glycyrrhiza root.  This traditional Chinese medicine mix has been reputed to be a stimulator of the immune system and helping fatigue and anemia. This small study in patients who underwent major hip surgery looked at how effective it was  in boosting red blood cells.  How effective was it?

Donating your own blood prior to big surgery like this is fairly common and is called autologous blood donation.  The idea is that if you donate your own blood and then recover a bit, then have the surgery, your body has enough time to build up your hemoglobin and oxygen carrying red blood cells.  That way in the event you need blood, you can get your own blood back.  This study looked at patients undergoing hip surgery who donated autologous blood. In all cases, the recovery of hemoglobin levels was faster in those who were taking Juzentaihoto, and the results were statistically significant.  This means, the effect was not likely due to chance alone.    If it works here, it suggests that this herbal will increase hemoglobin levels in any situation where anemia may be causing fatigue.

Juzentaihoto (TJ-48), a traditional Japanese herbal medicine, influences hemoglobin recovery during preoperative autologous blood donation and after hip surgery.

Int J Clin Pharmacol Ther. 2009 Dec;47(12):716-21

Authors: Kishida Y, Nishii T, Inoue T, Nishida S, Arimitsu J, Yoshikawa H, Sugano N

OBJECTIVE: Preoperative autologous blood donation is a widely used alternative to allogenic transfusion in hip surgery. However, it has been reported that autologous blood donation may induce preoperative anemia. Juzentaihoto (TJ-48) (Tsumura Co., Tokyo, Japan) is a Japanese herbal medicine that has been used to alleviate anemia. We investigated the effect of TJ-48 on anemia in the perioperative period. PATIENTS AND METHODS: 18 hips of 18 female patients who underwent total hip arthroplasty or rotational acetabular osteotomy (RAO) were divided into two groups. Group A consisted of 9 hips of 9 patients who were treated with TJ-48 at a dose of 7.5 g per day from 21 days before surgery to the day before surgery. Group B consisted of 9 hips of 9 patients who did not take TJ-48. Preoperative autologous blood donation was performed 21, 14 and 7 days before surgery. All patients deposited 400 ml each time for a total of 1,200 ml. Hemoglobin level was recorded on preoperative Days 21, 14 and 7 and postoperative Days 1, 4, 7 and 14. RESULTS: During the preoperative period, repeated measures ANOVA showed a significant difference between the two groups in hemoglobin level (p = 0.04). Despite the lack of TJ-48 after surgery, the rate of hemoglobin decline in Group A was less than in Group B at all examination times. No patients with TJ-48 experienced side effects, including gastrointestinal symptoms and unusual laboratory data. CONCLUSION: TJ-48 is useful for treating anemia during preoperative autologous donation.

PMID: 19954709 [PubMed - indexed for MEDLINE]

Technorati Tags: alternative cures, anemia, chinese herbs, herbs for anemia, Juzentaihoto (TJ-48), natural cures

Dr.Steve’s BOTTOM LINE: There are health risks for postmenopausal estrogen and women,  especially those at risk for breast cancer or have had estrogen sensitive cancer,  are steering clear of prescription estrogens.  MenoProgen  is an estrogen-free natural herbal product made with five well-known “herbal food” extractions.  The question is, does it work to relieve postmenopausal symptoms and is it safe?

This is an animal study which goes into a little bit of detail about some biochemistry behind how Menoprogen might work.   Other lab studies  and  human clinic trials have shown  that the product IS able to  reduce hot flushes, insomnia, vaginal dryness, loss of libido, mood swing, amnesia, anxiety etc.  Specifically it seems to work by increasing the body’s own estrogen production and does not act directly on estrogen receptors.  This last point is important for those worried about cancer effects.  However, if one’s own estrogen increases,  this may still affect the risk of cancer or cancer recurrence because that internal estrogen can certainly bind to estrogen receptors.  So, based on this,  the jury is out on whether or not there is decreased, equal or increased cancer risk.  More human safety trials are needed, especially in women who have had cancer. Having said that, based on this study, the natural herbal ingredients themselves should not affect cancer risk by any direct effect on estrogen receptors.

Estrogenic effects of the herbal formula, menoprogen, in ovariectomized rats.

Biol Pharm Bull. 2010;33(3):455-60

Authors: Ma H, Chung MH, Lu Y, Nishihara T, Hattori M

Despite the health risks for postmenopausal women, the indications and ideal candidates for hormone replacement therapy remain unclear. The present study used ovariectomized rats to examine the safety and effects of the Chinese herbal formula Menoprogen (MPG), which is prescribed for menopausal syndrome. Daily oral MPG (1000 mg/kg body weight) for 2 weeks significantly recovered uterine and adrenal gland atrophy and restored serum estradiol, estrone and progesterone levels that were decreased in rats by bilateral ovariectomy. However, yeast two-hybrid and nuclear receptor cofactor assays showed that MPG did not bind estrogen receptors alpha (ERalpha) and beta, and immunohistochemical staining revealed that unlike 17beta-estradiol, MPG did not stimulate the protein expression of ERalpha, progesterone receptor, c-jun and c-fos in the uterus. No side effects of MPG were confirmed in vivo. These findings suggest that MPG would be useful for treating women with premenopausal and postmenopausal syndromes.

PMID: 20190409 [PubMed - in process]

Technorati Tags: alternative cures, chinese herbs, menopause, Menoprogen, natural cures

Dr.Steve’s BOTTOM LINE: So you’re about to take your favorite herbal for something like irritable bowel or other ailment and then someone tells you the story they just read about Chinese herbs coming over with cow dung or other undesirable elements added in…. no extra charge!  Yuck! And, that’s not the whole story.  With cow dung come parasites.  Hmmm, maybe THAT’s why you have irritable bowel?   Well beyond this horror show, you also want to know if the ingredients are actually what they say they are.  How do you know?

There is something called GMP or Good Manufacturing Practices, which reputable herbal, supplement manufacturers and compounding pharmacies follow. This paper talks about the details of creating such a quality assurance program and the “technicalese” should get you to realize that you want herbals and supplements from manufacturers that are proudly using such GMPs. It costs more to do this, but the peace of mind is worth it. Bottom line: look for evidence of GMP standards noted on the label or insert and shy away from buying directly from overseas. That “pure” herb you ordered up may be pure dung and parasites.

Quality assurance for Chinese herbal formulae: standardization of IBS-20, a 20-herb preparation.

Chin Med. 2010 Feb 22;5(1):8

Authors: Ip SP, Zhao M, Xian Y, Chen M, Zong Y, Tjong YW, Tsai SH, Sung JJ, Bensoussan A, Berman B, Fong HH, Che CT

ABSTRACT: Background The employment of well characterized test samples prepared from authenticated, high quality medicinal plant materials is key to reproducible herbal research. The present study aims to demonstrate a quality assurance program covering the acquisition, botanical validation, chemical standardization and good manufacturing practices (GMP) production of IBS-20, a 20-herb Chinese herbal formula under study as a potential agent for the treatment of irritable bowel syndrome. Methods Purity and contaminant tests for the presence of toxic metals, pesticide residues, mycotoxins and microorganisms were performed. Qualitative chemical fingerprint analysis and quantitation of marker compounds of the herbs, as well as that of the IBS-20 formula was carried out with high-performance liquid chromatography (HPLC). Extraction and manufacture of the 20-herb formula were carried out under GMP. Chemical standardization was performed with liquid chromatography-mass spectrometry (LC-MS) analysis. Stability of the formula was monitored with HPLC in real time. Results Quality component herbs, purchased from a GMP supplier were botanically and chemically authenticated and quantitative HPLC profiles (fingerprints) of each component herb and of the composite formula were established. An aqueous extract of the mixture of the 20 herbs was prepared and formulated into IBS-20, which was chemically standardized by LC-MS, with 20 chemical compounds serving as reference markers. The stability of the formula was monitored and shown to be stable at room temperature. Conclusion A quality assurance program has been developed for the preparation of a standardized 20-herb formulation for use in the clinical studies for the treatment of irritable bowel syndrome (IBS). The procedures developed in the present study will serve as a protocol for other poly-herbal Chinese medicine studies.

PMID: 20175906 [PubMed - as supplied by publisher]

Technorati Tags: alternative cures, chinese herbs, GMP, herbal purity, natural cures, pure herbs, quality herbals

Dr.Steve’s BOTTOM LINE: Painful periods are known as dysmenorrhea, in medicalese. Standard treatment depends on why the uterus is misbehaving, but include over the counter pain pills through heftier drugs and possibly surgery. There are really multiple causes, so this post is a tad too short to cover all that. Suffice it to say, especially if you’re living it or living with someone in this pain, it’s pretty miserable. Standard treatment often fails. So, what about the ancient art of acupuncture? Does it work?

This  large review of MANY published medical studies looked at how effective acupuncture is in helping control painful periods. Of the 27 studies published that were listed as “randomized” (the gold standard of clinical trials), only 9 really met the criteria of being well designed and carried out. Remember, although we can wish for results, it’s garbage in, garbage out. In other words a study that is lousy in design will not give you an accurate answer for what you are asking. To make a long story short, some of the studies showed VERY promising and effective results, while others were a bit less enthusiastic in results reporting. All of them had some flaws in design, but the bottom line is that some of then showed a clear advantage to acupuncture over the use of drugs or herbals. Bottom line? It’s worth a try and the risk is very low. BONUS tip:  try Vitamin E, Vitamin B1, Omega-3 Fish Oil, magnesium, not all together but one at a time….might help and there is decent research evidence for each.

Acupuncture for primary dysmenorrhoea: a systematic review.

BJOG. 2010 Feb 17;

Authors: Cho SH, Hwang EW  Background The effectiveness of acupuncture in primary dysmenorrhoea is not fully understood. Objectives To assess the effectiveness of acupuncture for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs). Search strategy Nineteen electronic databases, including English, Korean, Japanese and Chinese databases, were systematically searched for RCTs investigating acupuncture for primary dysmenorrhoea up to July 2008 with no language restrictions. Selection criteria All RCTs that evaluated the effects of acupuncture compared with controls were included. Studies that assessed the effect of moxibustion or body acupressure were excluded. Data collection and analysis The study abstraction and quality assessment of all studies were undertaken following the detailed descriptions of these categories as described in the Cochrane Handbook for Systematic Reviews of Interventions. Main results Twenty-seven RCTs were systematically reviewed. Only nine of the 27 trials clearly described their methods of randomisation and none of the trials stated the methods of allocation concealment. Compared with pharmacological treatment or herbal medicine, acupuncture was associated with a significant reduction in pain. Three studies reported reduced pain within groups from baseline; however, two RCTs did not find a significant difference between acupuncture and sham acupuncture. Author’s conclusions The review found promising evidence in the form of RCTs for the use of acupuncture in the treatment of primary dysmenorrhoea compared with pharmacological treatment or herbal medicine. However, the results were limited by methodological flaws. The evidence for the effectiveness of acupuncture for the treatment of primary dysmenorrhoea is not convincing compared with sham acupuncture. Further rigorous nonpenetrating placebo-controlled RCTs are warranted.

PMID: 20184568 [PubMed - as supplied by publisher]

Technorati Tags: acupuncture, alternative cures, natural cures, painful periods, painful uterus, pelvic pain

Dr.Steve’s BOTTOM LINE: Fatigue is common these days, and even aside from diagnoses of fibromyalgia and fatigue syndromes, all of us feel run down at some point or another.  A Chinese herb, Cistanche deserticola, commonly called Rou Cong Rong, has pharmaceutically active  materials. These are known in Chinese as suosuo dayun ( 索索大元), which are produced by slicing the stems of the plant. Unfortunately, the herb is on the world’s endangered species list so it this study about its fatigue fighting properties is right on, we may run out…… Does it work?

This research study was performed on rats, but what they measured is pretty objective and hard to fake. Specifically, in addition to checking time to exhaustion  from swimming, blood tests that measure muscle fatigue were checked.  These are common blood  tests that might be similarly used in humans. It appears that at least in rats, Cistanche deserticola is pretty active. No human trials, but this provides a scientific basis for its potential effectiveness.  One parting comment..  This is a specific type of Cistanche that was tested, others may not have the same properties (the Japanese Cistanche salsa for example).  Also be careful of the purity of anything you consider buying. Given the increasing rarity, it may be significantly cut by other herbs included in whatever mix is being sold.

Antifatigue activity of phenylethanoid-rich extract from Cistanche deserticola.

Phytother Res. 2010 Feb;24(2):313-5

Authors: Cai RL, Yang MH, Shi Y, Chen J, Li YC, Qi Y

A phenylethanoid-rich extract (ECD) of Cistanche deserticola Y.C. Ma, a holoparasitic plant and a valuable traditional Chinese medicine, was evaluated for antifatigue activity in ICR mice. ECD (0.25, 0.50, 1.00 g/kg) was administered orally to mice for 3 weeks. The swimming time to exhaustion was longer in the treatment groups (0.50, 1.00 g/kg) than in the control group (p < 0.01). The serum creatine kinase, lactate dehydrogenase and lactic acid levels were decreased significantly in the treatment groups compared with the control group, while the contents of hemoglobin and glucose were increased significantly. In conclusion, ECD appeared to enhance the swimming capacity of mice by decreasing muscle damage, delaying the accumulation of lactic acid and by improving the energy storage. These results provide scientific evidence for the traditional Chinese medical practice of C. deserticola.

PMID: 19610039 [PubMed - indexed for MEDLINE]

Technorati Tags: alternative cures, chinese herbs, natural cures