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I dl in--- -- www.indena.it Headquarters: lndena S.p.A. - Viale Ortles, 12 - 20139 Milan - Italy - tel. lndena USA, Inc.- 1001 Fourth Avenue Plaza, Suite 371 4- Seattle, WA 98154- tel.... ""' .,.,.._ lndena USA East, Inc. - 1719 Route 10 East, Suite 311 - Parsippany, NJ 07054- tel -~rtly Extracting Nature's Goodness™ ~3!!U~ SAW PALMETTO, KAVA, GINGER, ROSEMARY, COFFEE, TEA & NATURAL ANTI-OXIDANTS U.S. Nutraceuticals offers an innovative line of SuPure™ supercritical fluid extracts. The SuPure™ C02 process is a state-of-the-art nrnrD.nure that optimizes the supercritical fluid ..~~'""' A'Il'T action process, maximizes the amount of active redients and eliminates any possibility of contamination from toxic solvents. Our raw materials division supplies ethically harvested BOTANICALS, a line of NATURAL TOCOPHEROLS and PHYTOSTEROLS. For more information on these products and the SuPure TM process, please contact us at:
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The American Botanical Council is the leading nonprofit education and research organization disseminating science-based information to promote the safe and effective use of medicinal plants and phytomedicines.
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ince 1988, the nonprofit American Botanical Council Educational Literature has worked to educate the public, healthcare practition S ABC continues to develop and dis ers, media, and government agencies on the safe and effec tribute educational literature to tive use of medicinal plants and phytomedicines. Individu advance the field of phytomedicine. als , organizations and companies who share our vision As an independent research organi support our goals through membership. Our members zation, ABC publishes health and receive benefits including: therapeutic information on herbs in its • Our highly-acclaimed journal Herba!Gram literature. A complete range of booklets, pamphlets and • Access to information on our website, reportS are published and distributed worldwide to stu www.herbalgram.org dents, educators, healthcare providers, and researchers. Your membership dollars help us provide this information. • Free and discounted research from our education department Educational and Research Initiatives • Discounts on publications from our Herbal The ABC Education Department administers an active Education Catalog internship program for students of pharmacy and dietetics. Your membership supports these important initiatives: The department initiates research projects and is available to answer questions from members, Media Education Campaign the media and industry representa- Your membership This critically important program continues to make a rives. in the American major impact on reducing the proliferation of inaccurate Botanical Council and/or negative media reports regarding herbal medicine. ABC Headquarters and contributions ABC responds to inaccuracies and misrepresentations, and In 1998, ABC acquired an historic 2.5 to our efforts make provides stories on successes in herbal medicine and acre site originally known as the Case our work possible. science-based information. Mill Homestead. The property encom passes a 150-year-old main building, Herb Clip TM Educational Mailing Service educational facilities, materials inventory building, green HerbClip provides critical reviews of impor house, rainwater collection system, and 15 medicinal tant new articles drawn from a variety of theme gardens. Healthcare professionals and visitors professional and mainstream sources. This from all over the world attend seminars and tour these service distributes valuable information facilities that are maintained through your membership regarding the research, marketing, and contributions. Planned expansion will be possible responsible use of medicinal plants. With through additional funding. more than 1500 entries, HerbClip has emerged as one of the leading Health Professional Education Projects databases in the herbal medicine movement. Selected ABC is involved in providing continuing education oppor research scientists, scholars, industry leaders, and ABC tunities for health professionals. Projects are produced by sponsors are sent this information bimonthly. You can also ABC in conjunction with the accrediting agencies in each receive this important information by joining at the appro health profession. In addition to continuing education priate membership level. modules, ABC sponsors ethnobotanical tours that offer credit for courses set in the rainforests of Africa and Peru. e need and appreciate your Such tours further the understanding of the importance support as we achieve our of preserving indigenous cultures and plants throughout W mission to increase public the world. awareness and professional knowledge The latest CE book, The ABC Clinical Guide to Herbs, of the scientific research and promis consists of comprehensive monographs on widely used ing potential of botanical medicines. herbs, plus a clinical overview, a patient information If you value the services we provide, sheet, table of clinical studies listing brands tested for please take a moment now to com each herb, and other unique features. plete the enclosed application form. Membership Levels You can also join online. We thank yo u for your support. Individual - Benefits include membership card, one year subscription to HerbaLGram, free herbal medicine book, ·------~ access to password protected areas of the ABC website, Yes, I want to join ABC including HerbalGram archives, discounts on merchandise Please detach appli cation and mail ro: from the Herbal Education Catalog, free initial research America n Botanical Council, Post Office Box 144345, Austin, session with our education department (up to 20 min TX 787 14-4345 or join online at \V\vw.herbalgram .org utes) and 40% discount on additional research. $50 0 Indi vidual- $50 0 Academic- $100 annually, discounts for seniors and students available. 0 Profess ional - $ 150 0 Orga niza tion - $250 (Add $20 postage for international delivery for above levels.) Academic - All benefits above, plus online access to: 0 Corporate and Sponsor levels. 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Cindy K.Angerhofer, Ph.D ., Research Director. Adriane Fugh-Berman, M.D., Author. Member, Joseph E. Pizzorno,Jr., N.D., President Emeri Tom's of Maine, Kennebunk, Maine Institute of Medicine Committee to Establish a tus, Bastyr University, Seattle, Washington John Thor Arnason, Ph.D., Professor of Biology, Framework for Evaluating the Safety of D iet ary Mark J. Plotkin, Ph .D., Author. Executive Direc Department of Biology, University of Ottawa, Supplements, Washington, DC tor. Ethnobotany and Conservation Team, Ontario, Canada Joe Graedon, M.S., Author. syndicated colum Arlington, Virginia DennisV. C.Awang, Ph.D., F.C.I.C., MediPiant nist, radio host, Durham, North Carolina John M. Riddle , Ph .D., Professor of History. Natural Products Consulting Services, White Mary Hardy, M.D., Director. Cedars-Sinai Department of History. North Carolina State Rock, B.C., Canada Integrative Medicine Medical Group, University, Raleigh Manuel F. Balandrin, R.Ph ., Ph .D., Research Los Angeles, California Eloy Rodriguez, Ph.D., James Perkins Professor Scientist, NPS Pharmaceuticals, Salt Lake City, Christopher Hobbs, L.Ac., AHG, Herbalist, of Environmental Studies, School of Agriculture Utah botanist, licensed acupuncturist, Williams, & Life Sciences, Cornell University. Ithaca, New Bruce Barrett, M.D., Ph.D ., Assistant Professor Oregon York of Fam ily Medicine, University ofWisconsin David Hoffmann, B.Sc ., M.N.I.M.H., Medical Victor Sierpina, M.D ., Associate Professor of Madison Medical School herbalist, Santa Rosa, California Family Practice Medicine, University ofTexas Marilyn Barrett, Ph.D., Pharmacognosy Maurice M. lwu, Ph.D., Bioresources Medical Branch, Galveston Consulting Service, San Carlos, California Development and Conservation Program, James E. Simon, Ph .D., Professor of New Use Bradley C. Bennett, Ph.D., Associate Professor Senior Research Associate at the Division of Agriculture, Director of the Center for New of Biology, Florida International University, Experimental Therapeutics, Walter Reed Army Use Agriculture and Natural Plant Products, Miami Institute of Research, Washington, D.C. Rutgers University, New Brunswick, New Jersey Joseph M. Betz, Ph.D., Director of the Dietary Timothy Johns, Ph.D., Associate Professor. Beryl Simpson, Ph.D., C. L. Lundell Professor of Supplements Methods and Reference Materials School of Dietetics and Human Nutrition; Botany, Department of Botany. University of Program, Office of Dietary Supplements, Director. Centre for Indigenous People's Nutri Texas at Austin National Institutes of Health, Bethesda, tion and the Environment (CINE), McGill Uni S. H. Sohmer, Ph.D., President and Director. Maryland versity, Montreal, Canada Botanical Research Institute ofTexas, Fort Peggy Brevoort, Co-founder and former CEO Steven King, Ph.D., Senior Vice President of Worth of East Earth Herb, Eugene, Oregon; former Ethnobotany and Conservation, Shaman Botan Barbara N. Timmermann, Ph .D. , Professor of President, American Herbal Products Associa icals.com, South San Franci sco, California Pharmacology and Toxicology, College of Phar tion, Seattle, Washington Thomas L. Kurt, M.D., M.P.H ., Clinical Profes macy, University of Arizona, Tucson Francis Brinker, N.D ., Lead Instructor on sor, Department of Internal Medicine, Universi G. H. Neil Towers, Ph.D., Professor Emeritus, Botanical Medicine for Associate Fellows, ty ofTexas Southwestern, Dallas F. R. S. C., Botany Department, University of Program for Integrative Medicine, University of Tieraona Lowdog, M.D., Herbalist, Family prac British Columbia, Vancouver. Canada Arizona, Tucson. tice physician, Assistant Clinical Professor. Uni Arthur 0 . Tucker, Ph.D., Research Professor of Donald J. Brown, N.D., Director, Natural Prod versity of New Mexico Medical School, Albu Agriculture and N atural Resources, Delaware ucts Research Consultants, Seattle, Washington querque State University. Dover Thomas J.S. Carlson, M.S., M.D., Associate Tom Mabry, Ph .D., Professor of Plant Biochem Nancy Turner, Ph.D., Professor and Ethnob Adjunct Professor. Department of Integrative istry. Department of Botany. University ofTexas otanist, Environmental Studies Program, Univer Biology; Director. Center for Health, Ecology, at Austin sity ofVictoria, British Columbia, Canada Biodiversity, & Ethnobiology; Curator of Eth Gail B. Mahady, Ph.D., Research Assistant Pro Daniel T. Wagner, R.Ph., MBA, Pharm.D ., nobotany, University and Jepson Herbaria; Uni fessor. Department of Medical Chemistry & Owner. Nutri-farmacy, Wildwood, Pennsylvania versity of California, Berkeley Pharmacognosy, College of Pharmacy. University of Illinois, Chicago Andrew T. Wei I, M.D., Author. Director of the Jean Carper, Author and syndicated columnist, Program in Integrative Medicine and Associate Washington, D.C. Robin J. Maries, Ph.D., Associate Professor of D irector of the Division of Social Perspectives Jerry Cott, Ph.D., President, PsychoFarmacolo Botany, Brandon University. Brandon, Manitoba, in Medicine, College of Medicine, University of gy Consulting Services, College Park, Maryland Canada Arizona, Tucson Paul Alan Cox, Ph.D., Director. National Dennis J. McKenna, Ph.D., Consulting Bernd Wollschlaeger, M.D., Family practice Tropical Botanical Garden, Kauai, Hawaii Ethnopharmacologist, Institute for Natural physician; Clinical Assistant Professor of Medi Products Research; Senior Lecturer. The Center Lyle E. Craker, Ph.D., Professor, Department of cine and Family Practice, University of Miami, for Spirituality and Healing, Academic Health School of Medicine, Florida Plant and Soil Sciences, University of Massachu Center at the University of Minnesota, Min setts, Amherst neapolis ad hoc advisor: Edward M. Croom, Jr., Ph.D., Scientific and Daniel E. Moerman, Ph .D., William E. Stirton David M. Eisenberg, M.D., Director, Center for Regulatory Affairs Manager. lndena USA East, Professor of Anthropology, University of Alternative Medicine Research, Beth Israel Inc., Paramus, New Jersey Michigan/Dearborn Hospital/Harvard Medical School, Boston, Massachusetts Wade Davis, Ph.D., Author. ethnobotanist, William Obermeyer, Ph .D., Vice-President of Washington, D.C. Research and Technology, ConsumerLab.com, Steven Dentali, Ph.D., Dentali Associates, Annapolis, Maryland Delray Beach, Florida Samuel W. Page , Ph.D., Director. Division of Hardy Eshbaugh, Ph .D., Professor of Botany & Natural Products, Center for Food Safety and Assistant Curator. Willard Sherman Turrell Applied Nutrition, U.S. Food and Drug Admin Herbarium, Miami University, Oxford, Ohio istration, Washington, D.C.
4 HerbaiGram 54 2002 Dear Reader he current buzz in herb circles is HERBAIGRAM T over the potential hepatotoxicity The Journal of the American Botanical Council of kava. Abour 30 cases of liver toxi city have been reported in Switzer Mark Blumenthal Editor I Publisher land and Germany, prompting Swiss Karen Robin Managing Editor officials to ban an acetone-based kava extract in 2000. In November Sean Barnes Art Director German officials sent letters to kava Steven Foster Associate Editor manufacturers proposing withdrawal Maureen Jabl inske Proofreader of drug licenses for kava. This has set off a chain reaction of scrutiny by other governments and LeAnne Hunt Intern a spate of articles in Europe, the U.S., and elsewhere. In December the U.S. Food and Drug Administration, after Contributors learning of the situation from a coalition of industry trade Christina Allday-Bondy Barbara Johnston groups, sent a letter to physicians requesting reports of Donald Brown Maryellen Molyneaux Subhuti Dharmananda Carolyn Williams Orlando liver toxicity associated with the herb. T he dietary supple Christopher Hobbs Paul Stamets ment industry in the UK, working with government offi David Hoffmann DensieWebb cials, voluntarily suspended kava sales until such time as Alici a Goldberg Kim West the question of liver toxicity is resolved. In January the French government banned kava products and other gov ernments are reportedly considering warnings to be post American Botanical Council Staff ed in retail outlets or enhanced label warnings. Trey Benn ett Tara Hall Cecelia Thompso n This comes as somewhat of a surprise to most industry Web Design Special Projects Finance members, health professionals and consumers familiar Kathleen Coyne Tanja Kunz Jan Veenstra with the historical and clinical use of kava. Little evidence Purchasing Education Herl:JCiip Editorial in the scientific literature suggests liver toxicity, with only Cheryl Dipper Judy O sburn Kim West Administration Administration Reception a few reports before 1998; it has enjoyed safe use for cen Gayl e Engels Geo rge Solis Margaret W right turies in Polynesia. Published controlled clinical trials have Communications Shipping Accounting not revealed liver toxicity. No one is sure what is going on. Neither the detailed W ayne Silverman, Ph.D. clinical case reports nor animal toxicology data are avail Chief Administrative Officer able for evaluation by U .S. experts. Contamination has been ruled out as the products implicated come from var Subscnpt1ons are a benefit of membersh1p at any level. One year memberships: lnd1v1dual $50: ious sources. No definitive mechanism explains the alleged Academic $1 00: Profess1onal $1 50: Organizat1on $250. Add $20 for memberships outs1de of the U.S. Student. Sen1or and Bus1ness Membersh1ps also available. see ad in this 1ssue.© 2002 toxicity. Polynesians blame the European extracts, saying American Botanical Council. ISSN #0899-5648. Pnnted in the U.S.A. that the traditional kava beverages do not produce liver The information in Herba/Gram is intended for educational purposes only and is not a substi problems. This assertion has not been proven. tution for the advice of a qualified health care professional. Although we attempt to ensure that advertising in Herba/Gram is truthful and not misleading. the publication of an ad for a Assessments by European experts of the 30 toxicity cases product or company in Herba/Gram does not constitute an endorsement by ABC of the reveals that some are associated with conventional drugs product or the company being advertised. Publication of an ad that makes a health claim or with known hepatotoxicity effects or use with alcohol. structure-function claim does not necessarily constitute an approval of that claim by ABC. One analysis suggests that the incidence of kava hepatoxi city is similar to the benzodiazepine drugs (benzodi Board ofTrustees azepines are not generally considered hepatotoxic). In Mark Blumenthal (President), Founder and Executive some reports people consumed kava at rates up to four Director times higher than the Commission E suggested dose Mi chael J. Balick, Ph.D., Director and Philecology (60-120 mg kavalactones per day). Experts point to other Curato~ Institute of Economic Botany. The New York Botanical Garden. Bronx. New York potentially confounding co-factors that raise questions James A. Duke (Treasurer), Ph.D., Economic Botanist about kava's association in many of the reports. ABC (USDA. ret.) Autho~ Fulton. Maryland issued a press release on the matter in December, and is Norman R. Farnsworth (Secretary), Ph.D., Research now working with a coalition of trade associations to prop lvviERICf'N Professor of Pharmacognosy. Program for Collaborative erly evaluate the case reports; however, adequate informa BoTI'NICAL Research in the Pharmaceutical Sciences. University of COUNCIL Illinois at Chicago tion is lacking for a proper assessment at the time of this Steven Foster, President. Steven Foster Group, Inc .. writing (late-January). More information on this issue will Educating the Fayetteville. Arkansas be posted on the ABC website,
2002 HerbalGram 54 5 Number 54
2002
The Journal of the American Botanical Council
11 ABC News Preliminary Research Suggests Catnip Effective as Mosquito Repellent ABC Advisory Board Expands to Include Added Expertise Berry Good for You 8th Annual Pharmacy from the Rainforest Tour NIH Creates New Web-Based Registry of Clinical Huge Success Trials ABC to Publish New Clinical Guide to Herbal New Species May Revolutionize Anti-Cancer Medicines Medications ABC Names Volunteer of the Year, Honors Those Who Donate Talent 21 Research Reviews Elderberry Enhances Immune Function by 14 Organization News Increasing Inflammatory Cytokine Production New Monographs Added to the American Mistletoe Extract Shows Promise in Treatment Herbal Pharmacopoeia Series of Hepatitis C in Small, Uncontrolled Study Experts to Publish Chinese Herb Safety Asian Ginseng May Help Speed Healing Time Guidelines in Patients with Chronic Bronchitis Taking Industry Coalition Advises Against Use of Antibiotic Drugs Dietary Supplements as Anthrax Remedy, Cure 23 Clinical Update 17 Research & World News Herbal Ear Drops Effectively Treat Ear Pain Selected Herbs Added to ObGyn Menopause Associated with Acute Otitis Media Practice Guidelines Flaxseed Supplemented, Low-Fat Diet May Phytonutrient Database to Survey Health Influence Prostate Cancer Progression Benefits of Plants 62 Legal & Regulatory 70 Book Reviews Trade Organizations, Court and Government Actions The Principles and Practice of Phytotherapy: Modern Affect Herbal Industry Herbal Medicine AHPA Announces Self-Regulatory Policies on Herb Growing Gourmet and Medicinal Mushrooms, Safety Labeling and Patient Disclosure of Herb Use Third Edition GAO Issues Report on Health Products for Seniors Herbal Prescriptions for Health and Healing and Senate Committee Holds Related Hearing Natural Dietary Supplements Pocket Reference Herb Industry Members Win California Prop 65 Medieval Herbals: Illustrative Traditions Case: Alcoholic Herbal Extracts Not a Health Problem FDA Clarifies Position on Marketing "PA-free" 73 Journal Reviews Comfrey Products Journal of Ethnopharmacology: An interdisciplinary Congress Gives FDA More Money to Regulate journal devoted to indigenous drugs Supplements 74 In Memoriam 64 Market Report Bernard Jensen Consumer Attitudes Predict Upward Trends for the Herbal Marketplace Heber W. Young ken, Jr. C. Norman Gillis 66 Conference Report Traditional Knowledge Summit Builds Bridges of 76 Letters Intercultural Understanding for Ethnoscience, Conservation, Sustainable Development, Medicinal 78 Calendar Plant Research and Cultural Survival 79 Access
80 Classified
Herba/Gram is printed on recycled paper at Wetmore Printing Company, Houston, Texas THE AMERICAN BOTANICAL COUNCILS The ABC Clinical Guide to Herbs
----·---- The 1\meric.ul Botanka] C:.OU.:il ow does the healthcare professional effectively respond to patient inquiries THE AB C CLINICAL H on the use of herbal supplements? What clinical research has been con GUIDE ducted? How is safety evaluated? This evidence-based educational course answers these and other questions for healthcare professionals, pharmaceutical companies, health management companies, policy makers, the dietary supple ment industry and consumers.
l~ National Continuing Education Credit for Physicians, Physician Assistants, Osteopaths, Pharmacists, Nurses, Nurse Practitioners, Dietitians, and N aturopaths
l~ 400+ page self-paced course/ reference including comprehensive clinical monographs, clinical overviews, patient information sheets and references for 29 widely used herbs and additional information on Senior Editor Senior Writers numerous proprietary multi-herb products Mark Blu menthal Josef Brinckmann Bernd Wollschlaeger, M.D. Managing Editors l~1 Comprehensive clinical studies tables for each herb, including Kara Dinda, M.S. Technical Editors brand names of the products studied Alicia Goldberg Christina Allday- Bondy Tara H al l Tanja Kunz l~ Important information on safety and drug interactions
Comprehensive Clinical Monographs Answer Complex Questions
T hese monographs are an invaluable reference that provides in-depth information to the practitioner and suffi cient derail to answer many of the most complex patie nt questions. Each comprehensive monograph includes: an ove rview, description, primary uses, other potential uses, dosages and administration, pharmacological -- actions, mechanisms of action, contraindications, adverse effects, herb-drug interactions, safety ratings, regulato· .: ..:. -:::-·~·:::.:;:..... "7-:::_=.. : :::·::··; ..:_7.::. ry status in various countries, and a detailed table that summarizes many of the clinical studies co nducted to :..·-;~~:-:-_.. ~ <..": ;-·__ date and brand names of products used in the clinical studies.
The ABC Clinica l Guide to Herbs offers scientific research on 29 of the most popular and highly publicized herbs: • American ginseng • Chamomile • Evening • Ginkgo • Milk thistle • Asian ginseng • Chaste tree primrose oil • Goldenseal • Peppermint • Bilberry • Cranberry • Feverfew • Hawthorn • Saw palmetto • Black cohosh • Echinacea • Flax • Horse chestnut • St. John's wort • Car's claw • Eleuthero • Garlic • Kava kava • Tea, Green/Black • Cayenne • Ephedra • Ginger • Licorice • Valerian
In addition, proprietary multi-herb products are featured in a separate section. • Alluna" • Hochu-ekki-to" • Padma• Basic, 28 • Pycnogenol" • Enteroplant" • Hova" • PC-SPES" • Resistan" • Esberitox• • Liv.52" • Phytodolor" • Sinupret'" • Euvegal" forte • Nutrilite" • Prostagutt" forte
8 HerbalGram 54 2002 Continuing Education Credit Review the Latest Clinical Research for Healthcare Professionals -=-- -~ ·- -=- =-.=::. :.-:--.;:'·~-=-=·------·-- The ABC Clinical Guide to Herbs provides continuing The Clinical Studies Tables are a significant education (CE) credit in the U.S. for physicians, feature of the comprehensive monographs that physician assistants, pharmacists, nurses, dietitians, provide a review of the most important, pub and naturopaths. The accrediting agencies have ... ~ =- '[~-=ft%~? lished human clinical studies. The tables sum r-:=- :E. ::-.:r=::.-=-::.:.:;;: agreed upon one set of learning objectives and a marize the study conclusions and the brands ~:- ~ ~~:~ unified post-test. To receive credit, practitioners will used. Practitioners wi ll be able to check what send the response and post-test form to their the studies conclude about many of the prod respective accrediting agency along with a nominal ucts their patients are using or they may fee to receive credit. choose to make recommendations based on Physicians, Physician Assistants, and Osteopaths this information. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical
St. John's wort Use the Clinical Overviews Education (ACCME) through the joint sponsor ....,. ... _,..._._ as a Quick Reference ship of the Texas Medical Association and the ~ .. - American Botanical Council. Texas Medical Asso ·:- ·~{~~:; . The two-page Clinical Overviews will ciation is accredited by ACCME to provide contin give the practitioner a comprehensive pic uing medical education for physicians. ture of the herb at a glance. Based on the full monographs, the overviews provid e a Texas Medical Association designates this CME streamlined way to use the information in activity for up to 9.5 hours in caregory 1 credit -----·- .- _.. ;-.. toward the AMA Physician's Recognition Award. . the clinical setting. -. .... --- .. . -· ·-- Each physician should claim only those hours of credit actually spent in the educational activity. Naturopaths A total of 10 CE hours will be awarded by the American Botanical Council in collaboration with the Oregon Board of Naturo '>t .. lttl1n .. IVtlrl Patients Take Home Accurate pathic Examiners for the successful completion of Information this program. Nurses A total of 10 contact hours is provided by The one-page Patient Information Sheets the Texas Nurses Association which is accredited as may be duplicated by the practitioner and .. .. a provider of continuing education by the American given to patients. They contain the basic Nurses Credentialing Center's Commission on information rhat the patients need to safely ·-:-.,.- Accreditation. This approval meets Type I criteria and responsibly integrate herbs into their for mandatory continuing education requirements ove rall health management picture. toward relicensure as established by the Board of Nurse Examiners for the State of Texas.
Pharmacists A total of 1.2 CEU (12 contact hours) Underwriters will be awarded to pharmacists for the successful completion of this program. The Texas Pharmacy To date, m~or underwriting support for the project has been provided at the Association is approved by the American Council Visionary level by the Council for Responsible Nutrition, Horphag Research, on Pharmaceutical Education as a provider of Pfizer I Bionorica AG, and Ricola USA. continuing pharmaceutical education. Underwriting Partners include ABKIT, Inc., Campamed LLC, Enzymatic Dietitians A total of 12 CE hours will be awarded Therapy, Metabolife International, Inc., Pharmavite Corporation, to Dieticians and Dietetic Technicians by the PhytoPharmica, Rexall Sundown, GlaxoSmithKline, and Starlight International. Commission on Dietetic Registration (CDR) of the American Dietetics Association, through EcoNugenics, Inc., H erbalife International, Inc., and the Horst M. Rechelbacher Southwest Texas State University, for the successful Foundation provided funding at the Supporter level. completion of this program.
2002 HerbalGram 54 9 ---The Amcricata Botanical· -- Cou!k:il~ T H £ A B c ' From garlic to ginger, CLINICAL HUERBS feverfew to flax- what you don't know may be what you need to know. The ABC Clinical Guide to Herbs. Everything a researcher, consumer, or healthcare professional needs to know about the most popular herbal medicines.
et the facts with The ABC Clin ical Gu ide to Herbs. This refer ence work includes compreh ensive monographs, clinical "In the world G overviews, patient information sheets, and references for 29 of the of herbal medicine most commonly used herbs and 15 proprietary multi-herb prod publications, ucts. It clarifies the evidence concerning the safe and responsible this book does it all:' use of herbs for disease prevention and treatment. Get important brand, safety, and drug interaction information. -Victor Sierpina, MD, University of Texas Medical Branch Only $4 0 plus shipping and handling. !rem #905
Please copy this form and return to ABC by fax: 512/926-2345, mail to: P.O. Box 144345, Austin, TX 78714 or call us at 800/373-7105, ext.ll4
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10 HerbalGram 54 2002 News
ABC Advisory Board Expands to Include Added Expertise
n June 200 I, the American Botanical columnist, and a member of the herb Cindy K. Angerhofer, Ph .D. , is research I Council's Board ofTrusrees added twelve industry. director at Tom's of Maine in Kennebunk, members to irs Advisory Board. The new "Many of these people have been ass isting Maine, a manufacturer of perso nal care members bring rh e total to 53. Refl ecting ABC in va ri ous ways, prior to their appoint products and herbal supplements. She the wide range of professional disciplines ment to the board. Their membership offi earned a doctorate in ph armacognosy at the that constitute the study of herbal medi cially recognizes an already existing rel ation University of Minnesota and post-doctorate ci ne, the new appointees incl ude six physi ship," said ABC founder and executive at the University of Ill inois at C hi cago. cians with experience in herbal and/or inte director Mark Blumenthal. Bruce Barrett, M.D., Ph.D., is an Assis grative medicine, a doctor of pharmacy, a T he following are the new members of rhe tant Professor of Family Medicine at the naturopath, a pharmacognosist, an erh board: University of Wisconsin-Madison Medical nonurririonisr, an author and syndicated School. He has researched and published on echinacea for upper respiratory infections, 8th Annual Pharmacy from the Rainforest Tour and authored several rev iews of herbal med icines. His doctoral work in anthropology Huge Success in vo lved medicinal plant resea rch on the Atlantic Coast of Nicaragua. ore than 40 people attended ABC's 8th annual Pharmacy from the Rainforest Peggy Brevoort, co-founder and former tour to the Peruvian Amazon from October 27 through November 4, 2001. M CEO of East Earth Herb of Eugene, Ore Despite a big storm that made some of the paths impassable and the canopy walkway go n (now operating as A.M. Todd Botani unavailable fo r a time, attendees reported that the trip was fun, intellectually stimulat cals) , is a well -known pioneer in the herb ing, and professionally rewarding. (Doctors and pharmacists may earn continuing edu industry, has a background in herbal market cation credits for attending the seminars on the tour.) research, and is a former president of rhe Of special interest to some of the American Herbal Products Association. attendees was the encyclopedic knowl Francis Brinker, N.D., is the lead edge of the guides. The position of guide instructor on botanical medicine for associ in Peru is highly sought after and ate fellows at Andrew Weil 's Program for requires years of practical study, result Integrative Medicine at the Un ivers ity of ing in guides who are very well trained Arizona in Tucson. Author of numerous in the natural history of their region. articles and books, Brinker is best known Other items of interest in addition to for his ex tensive compilation, Herb Con the seminars are the wide variety of flora traindications and Drug Interactions, now in and fauna, interacting wi th people from its third edition. a different culture, and the perennial Life in the rainforest of the Amazon. favorite, the canopy walkway that soars Adriane Fugh-Berman, M.D., is an Assis Photo © 2002 Trey Bennett 110 feet above the rainforest floor. tant Clinical Professor in the Department of Health Care Sciences at George Washington For more information on any of the tours below, call Kim at 512/926-4900, ext. 101 University School of Medicine. She is the or email
2002 HerbalGram 54 11 ~~~ABC News
ABC to Publish New Clinical Guide to Herbal Medicines
D esponding to the popularity of herbal cation (CE) credit. This special continuing 29 herbs and the brands used in each study. ~u pplements , the American Botanical education module will allow physicians, Two-page C linical Overviews serve as a Council (ABC) announces its latest in osteopaths, physician's assistants, pharma quick reference. Its one-page Patient Infor depth reference work. The ABC Clinical cists, nurses, nurse practitioners, dietitians, mation Sheets are specially designed for Guide to Herbs is a comprehensive study of and naturopaths to utilize the book to earn practitioners to distribute to patients who the most commonly used herbs and their CE credit. have questions concerning the responsible potential relevance to mod Mark Blumenthal, senior use of these herbs. Also, the Guide presents ---·--- ern clinical medicine. The editor of the Guide and information on 15 proprietary products. THi ABC Guide provides a multi CLINICAL founder and executive direc "We are responding to the requests of GVIDR TO dimensional, accurate, and tor of ABC, said, "This book physicians who want evidence, studies, thorough look at the current HERBS has been three years in the brands, and other related information avail clinical research on these making, and is one of the able in both at-a-glance and in-depth for major medicinal herbs. most thorough and timely mats," Blumenthal said. By providing the underly works of irs kind. Healrhcare The ABC Clinical Guide to Herbs is sched ing science necessary to help professionals, researchers, and uled for publication during 2002, and wi ll understand the safe and patients alike need to under be available for $40 plus shipping & han effective use of herbal medi stand the latest research find dling directly from ABC, and from a variety cine, ABC has delivered an ings on these herbs." of professional organizations, booksellers, important resource for pro- The Guide presents co m and other distributors. Advance orders may fessionals and interes ted con- prehensive therapeutic mono be placed direcrly with ABC. Turn to page 8 sumers and patients. It can be purchased as graphs that include extensive tables that for more derail s. A a resource book or used for continuing edu- summarize the clinical studies published on
ABC ADVISORY B OARD of Origins of Hu man Diet and Medicine: Most Influential Pharmacists in America" Continued from page 11 Chemical Ecological Approaches (fo rmerly (Pharmacy Times magazine 1999). He published as With Bitter Herbs They Shall founded the nonprofit Student Rainforest Eat It) . Fund, which takes college students in the Mary Hardy, M.D., a board-certified Tieraona Lowdog, M.D., is an herbalist, healing professions to the rainforest of internist, is the Medical Director of the family practice physician, and Assistant Belize, Central America. Cedars-Sinai Medical Center program in Clinical Professor at the University of New Bernd Wollschlaeger, M.D., studied Integrative Medicine. She has integrated Mexico Medical School in Albuquerque. conventional medicine and phytomedicine botanical medicine into her clinical practice She is a member of the White House Com in Germany, Israel, and the U.S. A family for many years and is involved in systemat mission on Complementary and Alternative practice physician in Miami, Florida, he is ic reviews of herbal medicine review topics Medicine Policy, a member of the U. S. an associate editor of the forthcoming ABC for the National Center for Complemen Pharmacopoeia's monograph advisory Clinical Guide to Herbs and is a contribut tary and Alternative Medicine and the panel, and author of numerous continuing ing editor of the journal of the American Office of Dietary Supplements at the medical education modules on herbs. Nutraceutical Association. RAND Corporation in Los Angeles. She has served as a technical expert adviser in Victor Sierpina, M.D., is an Associate Members of the Advisory Board are complementary and alternative medicine Professor of Family Practice Medicine at the actively involved with various aspects of for the California Board of Medicine. Also, University of Texas Medical Branch in the editorial process of HerbaiGram, Herb she is a regular workshop leader on ABC's Galveston, and author of Integrative Health Clip, and other ABC publications and Pharmacy from the Rainforest tours to the Care: Complementary and Alternative Thera projects. They also advise ABC on new Amazon and other areas and conducts pies for the Whole Person. He currently projects, organizational policy, and related numerous educational workshops for health direc ts an NIH-funded project to produce a matters.- LeAnne Hunt A professionals. model complementary and alternative med icine curriculum for medical schools. Timothy Johns, Ph.D., is an Associate Reminder Professor in the School of Dietetics and D aniel T. Wagner, R.Ph., MBA, Pharm.D., owns Nutri-farmacy, near Pitts Human Nutrition and Director of the Cen American Botanical Council tre for Indigenous People's Nutrition and burgh, which was awarded the "Innovative members receive a the Environment at McGill University in Pharmacy Practice of the Year for 2000" by Montreal, Canada, where he researches and Dupont. His awards include "National 5% discount on Herbal teaches on the role of plants in the develop Merit Award for 2000" (American Pharma Education Catalog items. ment of indigenous diets. He is the author ceutical Association), and "One of the Fifty
12 Herba!Gram 54 2002 ABC Names Volunteer of the Year, Honors Those Who Donate Talent
olunteers continue to play an impor A professional profits like ABC are able to offer thei r se rv Vtant role at ABC. As 2002 began, ABC researcher at the Uni ices to the public. We are delighted to staff reAected back on the many hours given versity of Texas for honor Shirley as our Volunteer of the Year by members of the community to help us over 30 years, Shirley for 2001. Thank you Shirley, on behal f of fu lfill our miss ion. Gratitude does not begin has been coming to all ABC staff and the thousands of people to describe the feelings ABC has for the our ABC every Wednes who benefit from our work!" standing people who freel y contribute their day for three years to Many other individuals have contributed time and talent to the organization. This o rga n1 ze and file countless hours to ABC. Volunteers have year ABC is beginning the tradition of much of our reference contributed to research efforts, resource naming a Volunteer of the Year to es pecial materials. Initially organization, project planning, fundraising, ly acknowledge one of these individuals. Shirley Beckwith this was a major marketing campaign development, garden undertaking, but Shirley has persevered and A nonprofit research and education planting and maintenance, as well as com helped to create a significa nt level of organ organization like ABC is dependent on a munity outreach. The assistance of these ization in our books, journals, magazines volunteers makes ABC's work much easier. large number of resources from which we and files- allowing ABC staff and visiting draw our herbal information. This includes Thank you to Denise Adams, Laurie interns the opportunity to access informa books, journals, magazine, newsletters, and Aroch, Amy Bysrrom, Rebekah Capers, tion in a much easier manner. numerous other materials. Keeping these Nathan Dav is, Maressa Gabriel, Susie reference resources organized has been a "Shirley is a treasure," says Education Gelbe, Ki zzy Hannibal, H ank H sieh, Ad ri Assistant Tanja Kunz. "I can't imagine what constant challenge to ABC employees and ane H oard, LeAnne Hunt, Ellie Loggins, interns, and requires a considerable amount we would do without her. " Jean Loveday, Liz MacDonald, Monica of time and energy. ABC was therefore Mark Blumenthal commented, "Shirley Naples, Susan Polasek, Jeffrey Potts, Bar thrilled several years ago when Shirley has generously donated her time and pro bara Springer, Raina Tillman, Sara Wallfisch Beckwith began offering her expertise while fess ional expertise, asking for nothing in and others whose names may have been completing her master's degree in Library return. It is through people like Shirley who missed. and Information Science. volunteer their time and energy that non- -Christina Allday-Bondy .A Planting the Future A Conference on the Cultivation & Preservation of Native Medicinal Plants Sunday, April 14, 2002 Lady Bird Johnson Wildflower Center Austin, Texas United Plant Savers' Presenters include renowned herbalists from across the country: mission is to preserve, Rosemary Gladstar, Christopher Hobbs, Pam Montgomery, conserve, & restore Steven Foster, Ed Smith, Ryan Drum, Mark Blumenthal, native medicinal Ellen Zimmermann & others. plants and their habitats in the Cost: $55 ($45 if you pre-register by April 1) United States & Sponsors: Whole Foods Market, American Botanical Council, clay artist Cindy Phillips, Canada, while Austin Sierra Club, The Herb Bar, New Texas Magazine and The Austin Herb Society ensuring their For more information or to register, send check or money order to: abundant, renewable United Plant Savers, P.O.Box 77, Guysville,Ohio 45735-0077 supply for future (740)-662-0041 - Email: [email protected] generations. All proceeds from this event go directly to United Plant Savers Lunch, beverages, plants, books and herbal products will be available for sale.
2002 HerbaiGram 54 13 Organization News
New Monographs Added to the American Herbal Pharmacopoeia Series
he American Herbal Pharmacopoeia (AHP) is bringing its for harvesting and dryi ng are not commonly known. Ultimately, T monograph series up to 16 with the release of four new mono our goal is to provide the information needed to produce a true graphs. The goldenseal (Hydrastis canadensis L., Ranunculaceae) quality product and how to use it appropriately," Upton said. root monograph was released in August 200 l , and the monograph The selection of species for monographs res ults from three ge ner- on bilberry ( Vaccinium myrtillus L., Ericaceae) was published in a! methods. In the first and most commonly used method, a prior- December 200 I. Black cohosh (Actaea racemosa L., Ranuncul aceae itization committee - made up of herbalists, naturopathic phys i- syn. Cimicifuga racemosa) and cranberry ( Vaccinium macrocapon Aiton, Ericaceae) are expected to be published by March 2002. Table I AHP Monographs Status Summary The goldenseal monograph is unique in that it includes research on berberine, one of Monograph Status ABC Price goldenseal's active compounds, and informa Order# tion on goldenseal's co nse rvation status. aged garlic extract in development International trade in wild and cultivated American ginseng root in development goldenseal, listed in Appendix II of C ITES Angelica sinensis root in development (the Conve ntion on International Trade in ashwagandha root complete #435 $ 19.95 Endange red Species of Wild Fauna and astragalus root complete #431 $ 19.95 Flora), is regulated to protect the species' bilberry fruit complete #441 $19.95 wild status. black cohosh rhizome 2002 The bilberry monograph includes quality control standards to black haw bark complete #436 $19.95 help ass ure authenticity and purity, and provides a therapeutic com chamomile flowers in planning pendium that critically reviews all current pharmacological and chaste tree fruit complete #437 $19.95 sa fety data, much of which has been unavailable in the U.S. cramp bark complete #438 $19.95 "Each monograph represents the most thorough and critical cranberry fruit 2002 review of all aspects of the plant available. It provides complete and dandelion leaf in pl anning reliable information regarding the true therapeutic potential and dandelion root in planning safety of the herb so that consumers and health professionals ca n Echinacea angustifolia make ed ucated decisions about its use, " said Roy Upton, AHP's root 2002 executive director. Echinacea purpurea AHP intends to publish 300 monographs on the most common leaf and root 2002 ly used herbs from Ayurvedic, C hinese, and Western traditions. garl ic powder in development Each monograph takes about one yea r to complete and several are ginkgo leaf 2002 in development concurrently, expl ained Upton. Monograph devel goldenseal root complete #440 $19.95 opment depends primarily upon financial support from the herb hawthorn berry industry. complete #430 $19.95 hawthorn leaf "With the recent downturn in certain segments of the industry, with flowe r complete #426 $19.95 fundraising has been difficult and time consuming. However, it is lemon balm herb in planning important for the industry to understand that the information pro vi ded by the AHP monographs is esse ntial for the manufacture of milk thistle seed in development quality products," Upton said. "An industry whose product quality nettle leaf in development is above reproach will grow and flourish , or if lacking, will contin nettle root in development ually struggle to build product confidence." reishi mushroom complete #439 $19.95 In Upton's opinion, increased product quality will lead to physi saw palmetto berry in pl ann ing cians and pharmacists prescribing herbal products, as is common in schisandra berry complete #434 $19.95 parts of Europe, and to insurance companies reimbursing co n St. John's wort herb complete #5420 $9.95 sumers. According to Upton, "Booms in individual herbs (like St. Revision 2002-2003 John's wort) as ide, this is what will lead to future sustained growth valerian root complete #427 $19.95 of the herbal products industry to a degree currently not envisioned willow bark complete #433 $19.95 by members of the industry." AHP monographs provide the most accurate information on The American Botanical Council sells the entire set herbs and herbal compounds to the medical community, the herbal of 14 monographs at a discounted rate for $255.00 industry, and to consumers according to Upton. "Much of the (order #450). To order, call toll free 800/3 73-71 05, already ex isting information is inconsistent or is nor utilized by fax 512/926-2345, email: [email protected] much of the industry. Even something as seemingly elementary as or order online at www.herbalgram.org knowing the proper identification or optimal time and conditions
14 HerbaiGram 54 2002 Organization News ~
cians, and herbal educati on and indusrry represem ari ves - com to the herbal industry, healrhcare professionals, ed ucational institu piles a li st of the co p I 00 selling herbs fro m informal surveys . T he tions, regulating bodies, and the general public about the appropri comminee evaluates the feas ibiliry of completing a monograph on ate use of botanicals. those species and narrows the li st to a co p 30, a top 20, and the co p "AHP monographs provide the fo undation fo r the manufactu re I 0. O nce the fi rst 30 monographs are completed , the comminee of safe and efficacious herbal products and to promote their eth ical will determ ine rhe nex t 30 most needed (see Table 1). marketing. Few other monograph systems provide rhe depth, com Some herbs are selected due co safery concerns. O ne such exam prehensiveness, or critical review achieved by the AH P mono ple is the ad ulcerati on of common Chinese herbs with pl am s from graphs," said Upron. "Additionally, each monograph provides the fa mily Ariscoloch iaceae. The U.S. Food and Drug Adminisrra derai led color phorographic images of rhe plancs char are invaluable tion (FDA) issued a warning co consumers in April 2001 about the for assessing idemificarion and qualicy concrol. T his is a unique fea dangers of kidney fai lure and cancer associated with one species of ture of AHP monographs nor found in any others." this plant, Aristolochia Jangchi (Y.C. Wu ex L. D . C hou & S.M. - LeAnne Hunt -'"" H wang), which may be accidenrly substituted in weight-loss prod *Editor's note: For more on this subject, see Chen j. Nephropathy Asso ucts that comain C hinese herbs*. AHP is collaborating with the ciated with the Use ofArisrolochia. H erbaiG ram 2000;48:44-5. Australian T herapeutic Goods Agency, the C hinese State D rug Administrati on, and the American H erbal Products Associati on co [American Herbal Pharmacopoeia. Announcing rhe Publication of AHP Monograph; Goldenseal Root Hydrastis canadensis. [Press release]. Augusr develop a monograph that contains aurhenci cari on res ting for 3, 200 I. plancs of fami ly Ariscolochiaceae and those plams that are com American Herbal Pharmacopoeia Rel eases Bilberry Monograph [Press monly adulterated with them. Work on this monograph is pro release]. December ], 200 I. gressing, bur sin ce it is outside the normal monograph production American Herbal Pharmacopoeia websire.
2002 HerbalGram 54 15 Organization News
Experts To Publish Chinese Herb Industry Coalition Advises Safety Guidelines Against Use of Dietary A n alliance of trade and professional associations has initiated li..a broad review of existing safety data on Chinese herbs and Supplements as Anthrax other traditional therapeutic substances . T he groups plan to pub lish their compiled research as a guidance document that will pro Remedy, Cure vide accurate safety informati on for healthcare practitioners, man T ike all Americans, the natural products industry is attentive ufacturers, regul atory agencies, and consumers. Lro the recent incidents of anthrax. As colleagues who sup "This project will consolidate traditional and modern safety port the responsible sale and use of health-promoting vitamins, information for hundreds of herbal and non-herbal ingredients in minerals, herbs and other dietary supplements, we strongly the Chinese materia medica into a single publication," said believe there are no dietary supplements that have been proven Michael McGuffin, President of the American Herbal Products to treat or prevent anthrax. In addition, federal regulations do Association (AHPA) . "It's a considerable undertaking, bur by not allow dietary supplements to claim to treat or prevent any cooperating with the acupuncture community we have put disease, including anthrax. together a team that incl udes some of the most knowledgeable Our organizations are therefore endorsing a unified advisory experts in the fi eld. " to marketers and retailers, as well as the consumers of dietary The envis ioned publicati on will be closely modeled after the supplements. We suggest and recommend: Botanical Safety Handbook, produced by AHPA in 1997 and now • Anyone who believes they may have come in contact with, consi dered to be a leading reference for herbal safety information. or are infected with, anthrax should immediately seek T his ea rlier book es tablished safety classi fications for more than medical treatment, 500 herbs, including a few broadly used C hinese herbs. T he new • Any suspected exposure to, or infection from, anthrax publication will prov ide gu idel in es on the safe use of individual should be reported promptly to your local health depart herbs and other ingredients included in the traditional Chinese ment, materia medica, and will include relevant data on iss ues such as restrictions on use, dose- related effects, toxic constituents, drug • Retailers of dietary supplements are urged to refuse to herb interactions, and preparati ons that affect toxicity. stock or sell any products that are presented as preventing or curing anthrax, and "With more and more Americans using Chinese medicine, it is critical that a reso urce such as this be developed so that there is a • Retailers should refrain from promoting any dietary sup clear understanding of each ingredient's safety profile, " said par plement as a cure or treatment for anthrax. ticipant David Molony, L Ac., Dipl. C.H ., Executive Director of Certainly there are natural therapies that have much to offer the American Association of Oriental Medicine (AAOM). "As a in terms of enhancing general immune resistance. However, practitioner, I know that this work will be useful for the hundreds therapies for the treatment or prevention of anthrax should of professionals practici ng this ancient form of medicine in this only be recommended by qualified public health authorities. country." The organizations listed here represent the majority of sup "For thousands of years many Chinese herbs have had a history plement manufacturers. Each of us, and all of our member of safe and effective use," added Kevin Ergil, LAc., M.S., director companies, remain committed to providing the American pub of Oriental Medicine at Touro College in New York City. "We lic with high-quality products that enhance our health and expect that this definitive guide will reinfo rce this ri ch history as "self-care" choices. Each of us is equally committed to recog it presents all of the known safety data in a clea r, concise and nizing those health conditions for which the choice of self-care comprehensive manner." Ergil is participating in the project as should be actively discouraged. The current anthrax threat has one of the representatives of the Council of Colleges of Acupunc created such a condition. ~ ture and O riental Medicine (CCAO M). Michael McGuffin, President The participating orga niza ti ons co nsist of the AAOM, the American Herbal Products Association, Silver Spring, MD American Herbal Pharmacopoeia, AHPA, the Acupunctu re and Michael Maves, President Oriental Medicine Al lia nce, CCAOM, and the Oregon College of Consumer Healthcare Products Association, Oriental Medicine. Publication is tentatively scheduled for 2004. Washington, DC For more in fo rmati on, contact Robin Gellman, john Cordaro, President and CEO
16 HerbalGram 54 2002 Research & World News ~
Selected Herbs Added to ObGyn Menopause Practice Guidelines
he American College of Obstetricians and Gynecologists lower dosage in the trial and the singular testing, when dong quai T (ACOG) now recommends a few selected herbal remedies for is traditionall y used in conjunction with other Chinese herbs. The management of menopausal sym ptoms. St. John's wort (Hypericum ACOG also warned that dong quai could be toxic, noting rhar irs perforatum L. , Clusiaceae), black cohosh (Actea racemosa L. , Ranun coumarinlike derivatives may cause excessive bleeding or interac culaceae; syn. Cimicifoga racemosa (L.) Nutt.), soy bean (GLycine tions with other anticoagul anrs. max Merr., Fabaceae), and isoflavones found in various legumes. In a clinical trial, ginseng and placebo had the sa me effect on In its Clinical Management Guidelines, published June 200 l , vasomotor symptoms, although improvements in overal l health and ACOG noted women's "lack of confidence in the espoused benefits well-being were reported. Citing the U.S. Pharmacopeia's 1998 of hormone replacement therapy (HRT) co upled wi th a significant valerian monograph, ACOG concluded that it appears not to be array of side effects of HRT, results in fewer than 1 in 3 women useful and may be harmful, noting a case report of acute symptoms choosing to take HRT." The guidelines noted that 30-40 percent of during withdrawal from valerian root. T he effectiveness of chaste women experience abnormal bleeding in the first yea r of HRT and tree has nor been sufficiently documented for the ACOG, bur a therefore stop treatment; further, fears of increased breast cancer risk study of its effect on premenstrual syndrome showed improve ment also lead women to avoid HRT altogether. in mood and a lessening of headac he and breast fullness . The T he ACOG guidelines also cite a survey by the North American ACOG reported that no benefit has been demonstrated by the use Menopause Society that reported more than 30 percent of women of wild or Mexican yam products. use alternative treatments such as herbal supplements, acupuncture, ACOG advises doctors to discuss and record a patient's use of natural estrogen, or phytoes trogens. herbal therapies, and provides pointers for counsel ing patients on Despite this use of alternatives to HRT, the ACOG panel con rhe benefits and risks of co mplementary and alternative medicine. cluded, "Given the ge neral lack of standardiza tion of products, the -LeAnne Hunt ...... relatively short duration of therapy and follow-up in the available [The American Co ll ege of Obstetricians and Gyneco logists. ACOG prac data, and the difficulty of interpreting the available clinical data, tice bu ll eti n: Use of botani cals for management of menopausal symptoms. few recommendations can be made with confidence." 200 I June 20;
2002 Herba!Gram 54 17 Research & World News
Preliminary Research Suggests Catnip Effective as Mosquito Repellent
aboratory ex periments co nducted at female mosqui toes in a glass rube, one end LIowa Stare Universiry (lSU) indicate of which was treated with neperalactone, a rhar rh e compounds in rhe esse ntial oil rhar biologicall y active characteristic constituent gives ca tnip (Nepeta cataria L., Lamiaceae) of catni p. Afrer 10 min utes in a high dose irs pungent, minry aroma are hi ghly effec enviro nment, 80 perce nt of the mosquitoes tive mosq ui to repellents. The report on rh e had moved to the un treated side of th e resea rch was delivered at the recent Ameri tube. In a low-dose test, 75 percent of the can Chemi cal Society's 222nd national mosquitoes moved away from the treated meenng. area. In the ex periments, Joel Coats, Ph.D. , T he researchers conducted sim il ar res ts Chairman of the Departm ent of Entomolo with DEET {dierhyl-meta-toluam ide), the gy at ISU, and Chris Peterso n, a U.S. Forest compound used in many commercial insect Service entomologist, res ted groups of repellents. In those tests, about 10-fo ld higher co nce ntrations of DEET were req ui red to obtain similar repe ll ency away from the treated side of the chamber. No animal or human res rs are scheduled Berry Good for You for ne peralactone. ISU has applied for a patent on the use of catn ip compounds as lueberri es, cranberries, huckleber insect repell ents. The project was funded by Bri es and re lated pl ants conta in the Iowa Ag ricul ture and Home Economics resveratrol, a pote ntia l anti cancer Experiment Station.
agent previously identified in dark A perennial herb in th e mint fa mily, cat Catnip Nepeta cataria. skinned bunch grapes, according to nip grows wild in much of the U.S. Also Photo © 2002 stevenfoster.com U. S. Department of Ag ri culture Agri cul tivated for commercial use, ir is known cultural Research Serv ice (ARS) scien for irs stimulati ng effect on cats, al though it rial Oil as a Mosquito Repellent. American ti sts. is also used in tea, and as a fo lk treatm ent Chemical Sociery's 222nd National Meeti ng, for fevers, colds, cramps and migra ine 2001 Aug 26-30; Chicago. Resveratrol (3,5,4-tri hydroxystilbene), Peterson C, Coats In sect Repel lents - Past, headaches . - Kim West A J. which prov ides antifungal protecti on Present and Future. Pesticide Outlook to grapes, also reduces the ri sk of car [Peterso n C, Rowley W, Coats J. Ca tnip Essen- 200 1;12(4): 154- 158.] diovascul ar di sease in humans, and ho lds potential as an anti cancer agent. That anticancer potenti al led to the search for resveratrol in other frui ts . ARS chemi st Agnes Rimando, Ph .D., at the ARS Natural Products Uti lizati on Research Unit in Oxford, Miss iss ippi, coll aborated with scienti sts at Agri cul ture and Agri-Food Canada, Kentvill e, Nova Scotia, and the ARS Small Fru it Research Stati on in Popl arvi ll e, Mi ss. to test resveratrol levels of 30 whol e frui t sampl es from fi ve families and 10 HERBAL SCIENCES BACHELOR'S species of Vaccinium. Findings show COMPLETION PROGRAM that resveratrol concentrati on vari es among the fruits. In muscadine grapes, Prepare for advanced studies or jobs the skins contain the hi ghest concen in the herbal products industry. supported by American Herbalist trati on, and the juice and pulp contain Accredited institution. the lowest. -LeAnne Hunt __... [425) 602•3330 / www.DIBSIYr.ltll [Becker H. Berri es may protect aga inst cancer and heart di sease. 2001 Feb. 27.
18 HerbalGram 54 2002 Research & World News
New Species May Revolutionize Anti-Cancer Medications
new species of Camptotheca promises to transform production Native to China and Tibet, C. acuminata is now al so found in Aof certain anti-cancer medications. Camptotheca lowreyana (Li , India, Japan, and Germany. Prior to the development of C. Cornaceae) received approval this past June from the U.S. Patent lowreyana, extraction of C PTs was difficult. CPTs are normally and Trademark Office, after eight years of research at Stephen F. extracted only from the seeds of the fruit of the tree, which rypical Austin State Universiry's (SFA) Arthur Temple Coll ege of Forestry ly are not produced until the trees are 6 to I 0 years old, and eve n in Nacogdoches, Texas. then the trees produce only several pounds of fruit annuall y. Fur This new species is an easily harvested source of camptothecin ther, these trees require tropical climates to reach maturiry; they are (CPT), a cytotoxic quinoline-based alkaloid that has been undergo not suited to temperate climates. Making CPT production even ing intense research since discovery of the plant's anti-cancer prop more difficult, C. acuminata has been listed as a national endan erties in 1958. CPT was isolated in 1966, and is currently the sec gered species in China, and the fruits, as well as the export of relat ond most important source of anti-cancer drugs in the world. CPT ed products, are under regulation by the Chinese government. - which has been modified to derive a host of other anti-cancer Shiyou Li, Ph.D., SFA research sciemist, developed the new drugs, including irinotecan, topotecan, and 9-aminocamptothecin species, C. lowreyana, commonly known as "Katie" - after Kati e - is expected to surpass taxol (taxanes) from the Pacific yew tree Northrup of Houston, Texas, who helped secure project funding. ( Taxus brevifolia Nun., Taxaceae) as the primary so urce of anti-can This new species is not a tree but a dense bush, and CPTs are cer drugs by 2003. Camptothecin and its analogs are being investi extracted from the leaves of the bush as early as si x months. Katie gated to treat a wide variery of cancers, but the compounds are quite is al so drought- and cold-tolerant and contains higher concentra toxic, and only topotecan (Hycamtin® by GlaxoSmithKiine, tions of CPT than C. acuminata. If developed into a crop, it may Philadelphia, Pennsylvania) and irinotecan HCI (Camptosar® by be harvested with machinery rather than by hand, lowering currem Pharmacia & Upjohn Company, Peapack, NJ) have met with FDA production costs. - Kim West, A BC .-4 approval. 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XCC100 $39.95 + S& H XSS100 $34.95 + S& H ' This statement has not been eva luated by the Food and Drug Administration. Thi s product is not in tended to diagnose. treat, cure, or prevent any disease. Wholesale inquiries welcome. Many other products are available. For a complete list of our ~t yc o ,\l e di c inals ® and other products. contact us for a free color brochure. or visit us on the Web at \\'Ww.fungi.com. FUNGI PERFECT! LLC PO Box 7634-HG • Olympia , WA 98507 • USA Order Toll-Free: (800 780 9126 • Fax: (360) 426 9377 • email: [email protected] • www.fungi.com 2002 Herba1Gram 54 19 Highest Quality Powders I Extracts To Enhance Your Nutritional Supplements Martin Bauer Br Finzelberg Deliver European Standardized Extracts Br GMO·free Powders Plus Value-Added High-Density Powders and Granulates. ,,, '•7;' Martin Bauer Martin Bauer, Inc. Herbal Powders for Health Supplements ,,, '•77 Finzel berg Finzelberg, Inc. Extracts for Pharmaceuticals & Health Supplements ,·.... _...... ·.· ~ ~:: ' .· .. :~,'::-~-:- .~~. ~ '\ .;' ··.·~-:". Call Toll Free at 1-877-797-HERB for Details Martin Bauer Group Your Partners for Botanicals from Seed Cultivation to Final Extract 2 Sylvan Way, Parsippany, NJ 07054-3806 oN THE WEB: www.martin-bauer.com/usa/ Research Reviews Review Compares Ginkgo Extract to Acetylcholinesterase Inhibitors ementia affects an estimated 4-8 percent of the world's popu cal efficacy of antidementia drugs by assess ing cognitive performance D lation, and increases with age. Treating the causes of using the cognitive subscale of the Alzheimer's Disease Assessment Alzheimer's dementia is not yet possible and only some of the fac Scale (ADAS-Cog scale). It is known from longitudinal studies that tors that are suspected to be of pathogenic relevance can be inAu the score of untreated Alzheimer's patients on chis subscale increases enced. Today, the various substances available for the treatment of by about four points on average over a six month period. Patients dementia can be broadly divided into three groups: conventional with relatively mild dementia deteriorate considerably more slowly nootropics (drugs which enhance cognition), acetylcholinesterase chan those with more severe forms. To even our this difference to a inhibitors (agents that inhibit the production of the enzyme that certain ex tent, the delay in symptom progression relative to the place breaks down the neurotransmitter acetylcholine), and extracts of bo patients' deterioration during rhe study was calculated. The review ginkgo (Ginkgo biloba L., Ginkgoaceae). Ginkgo, as far as is known, eval uated efficacy only in terms of order of magnitude. promotes blood circulation to the brain, which can enhance brain The review author concluded rhar efficacy, ex pressed as delay in activity. The impact of this on Alzheimer's is unknown. sy mptom progression or rhe difference in response rare between This review' compares published efficacy studies of four acetyl pati ents raking the active substance versus placebo, showed no cholinesterase inhibitors (merrifonare, rivastigmine, tacrine, major differences between rh e cholines terase inhibitory products donepezil; the latter three are approved in the U.S) and ginkgo and rhe ginkgo extract. EGb 761 should be considered an equally extract EGb 761® (Tebonin®, W Schwabe, Karlsruhe, Germany, effective treatment for mild to moderate Alzheimer's dementia. marketed in the U.S. as Ginkgold®by Nature's Way, Springville, Only racrine exhibited a high dropout rare due to adverse events. Utah, and as Ginkoba® by Pharmaton Natural Health Products, This review itself raises questions: for example, the comparison is Ridgefield, Connecticut). This review examined only randomized, not precise between such va ried patient populations. The key to placebo-controlled studies with a parallel group carried out in a dou future study is direct, double- blind, randomized clinical studies ble-blind fashion without enrichment or combination therapy, with char compare herbal products with specific pharmaceutical drugs; 24-30 weeks of randomized treatment and published results. Only for now, and the foreseeable future, such reviews as this are the patients suffering from Alzheimer's dementia were included in the alternative. studies of cholinesterase inhibitors. Patients in the EGb 761 studies - Densie Webb, Ph.D. -" generall y suffered milder stages of dementia, mostly of the I. Wenstein A. Cholinesterase inhibitors and Ginkgo ex tracts - are Alzheimer's type, although some had multi-infarct dementia. Only th ey co mparable in the treatment of deme ntia? Phytomedicine. two EGb 761 studies could be included in the review, and one for 1999/2000;6(6):393-401. each of the cholinesterase inhibitors. T he studies evaluated the clini- Mistletoe Extract Shows Promise for Hepatitis C Treatment in Small Study epatitis C virus (H CV) causes chronic liver disease and sets a five had a history of intravenous drug abuse. As injected Iscador can H stage for cirrhosis and hepatocellular carcinoma. Worldwide cause local skin reactions, rhe patients did a pretreatment wirh prevalence of chronic HCV is 170-200 million cases per year. Spon incremental doses of Iscador Qu of 0.1 mg, 1.0 mg, and 5.0 mg taneous virus disappearance is very rare in these cases, and standard prior to the study. None of the patients dropped our, nor reported treatment is a combination of Interferon-A (IFN-A) and Ribavirin any adverse effects, except for temporary ski n reactions at rhe injec (Schering Corp., Kenilworth, New Jersey) . T he response rate to this tion sire, during rh e 12-month study period. treatment is reported to be only 35-50 percent; unpleasant side In two of the five patients, a 6- to 20-fold reduction in vi ral load effects (headache, myalgia, arthralgia, fever, mental and emotional (HCV-RNA) and a complete remission of their elevated AST disturbances) often lead to poor compliance. Additionally, after dis (as partate aminotransferase) and ALT (alanine aminotransferase) continuation of treatment, relapses frequently occur. liver enzymes occurred. Normalization of AST and ALT indicate a This case series of five patients with chronic hepatitis C, treated for reduction in liver inAammation, and are correlated with a better one year with Iscador® (Weleda AG, Schwabisch Gmund, Germany; prognosis. T he authors further note that one of these patients had available under the trade name Iscar®from Weleda, Inc. of Congers, a strai n of HCV (genotype I B), which has greater resistance to con NY) an aqueous extract of European mistletoe ( Viscum album L. , ventional treatment. In one of the five patients, however, an Viscaceae), offers promising data. ' T his preliminary study found increase in vi ral load transpired. that subcutaneous injection of two ampoules of Iscador Qu (each T his report is seriously limited by irs small number of patients. A containing 1 ml aqueous extract of 5 mg mistletoe, standardized to drop in viral load in two patients hardly serves as evidence of suc 380 ng/mllectins and 14 mg/ml viscotoxins and harvested from oak cess, es pecially in such an uncontrolled setting and with such minis- trees (Quercus spp., Fagaceae), three rimes per day for one year was cule dosages. - Carolyn Williams Orlando -" well tolerated, decreased viral load and liver inAammation in two I. Tusenius KJ , Spoek JM, Kramers CW. Iscador Qu for chronic hepa patients, and generally improved quality of life. titis C: an exploratory study. Complementary Therapies in Medicine The participants entered rhe study with liver disease rel ated com 2001; 9:1 2- 16. plaints: tiredness, depression, and abdominal pain, and four of the 2002 HerbalGram 54 21 ._ .,. fl ""·~:. .... Research Reviews \ } Asian Ginseng May Help Speed Healing Time in Patients with Chronic Bronchitis Taking Antibiotic Drugs t any one rime, five perce nt of pati ents with chro ni c bronchi treatment) and 125 mg clavulanic acid rwice dail y for nine days. A tis worldwide experience acute arracks. Bac teri a cause 50-70 T hey were then randomized in to rwo groups. One group received percent of these acute arracks. Antibacteri al agents are, th erefore, only the antibacterial treatment, while th e second group received widely used to treat these pati ents. Although antibacterial treat 100 mg standardized ginse ng ex tract rw ice daily as oral tablets for ments are beneficial, they are not always effecti ve in sterilizing the nine days. whole bronchial sys tem. T here is a need for effective, ancillary Each morning, a sa mple of bronchial secretion was analyzed for treatments for patienrs with concomi tant diseases, a medical histo bacteri al count and the number of colony forming units. Pati ents ry of freq uenr infecti ons, and severe obstruction of the respiratory we re considered cured and the antibacterial therapy stopped upon sys tem, smce they derive onl y partial benefit from antibacteri al elimination of signs and sy mptoms of infections. The time to treatment. clearance of in fec ti on was the main clinical endpoin t. Both groups of patients responded positively to the antibacterial treatment. On average, the reduction in the bac terial co unt to below detection level occurred within seven days in both groups. However, in the group receiving G 11 5 ginse ng extract, bacterial clear ance was significantly fas ter, an average of 5.9 days in the ginseng and antibioti c group versus 6.7 days in the antibiotic only group (i.e., a 12 percent reducti on in rime to clearance of infecti on). The authors concluded that while a direct antibac terial effect attributable to ginseng is unlikely, its effi cacy as an ancillary treatment would mos t li kely be the res ult of an increased immune res ponse. While the small sample size of the trial did not allow the researchers to draw firm conclusions, it appears that patients suffe ring from ACB may heal fas ter if ginseng is given concomitantly with antibacterial medica ti ons. Further pl acebo-controlled, double-blind trials are now necessa ry to confirm the findings of this pilot Asian gin seng Ponox ginseng. Photo © 2002 stevenfoster.com trial. - Densie Webb, Ph. D. _. I. Scaglione K, Weiser M. Effects of the standardized ginseng extract Some reports have indicated that As ian ginseng (Panax ginseng G I 15"' in patients with chronic bronchitis: A non blinded, random CA. Mey. , Aral iaceae) may enhance antibody production and nat ized, comparative pilot study. Clin Drug Invest 200 1;2 1(1):4 1-5. ural ki ll er (NK) cell activity. T he findings of several studies suggest that ginse ng extrac t may play an important role in the prevention and therapy of respiratory disorders. T he ai m of this non-blinded, randomized, comparative pilot trial ' was to in ves ti ga te the effects of the standardi zed ginseng extract G 11 5® (G insana®, Pharmaton SA, of Luga no, Switzerland) in reducing bacterial counts in the The preceding bronchial sys tems of patients with acute bacterial arracks of chron HerbClip™ Research Reviews ic bronchitis (ACB). are examples of more than 1500 T he study, conducted by the University of Milan, included 44 critical reviews available online to members of AB C at the patienrs who we re age 18 years or greater and suffering fro m ACB. Academic level and above. T he full H erbC lip Educati onal Individ uals were excluded from the study if they had concurrenr Mailing Service is distributed bimonthly and includes 10-1 2 pneumonia, sys temic use of an anti-in fective drug in the seven days critical reviews along with many of the original articles drawn prior to enrollment, sys temic corticosteroid therapy (excluding the from a variety of professional and mainstream sources. To use of inhaled or intranasal aerosolized corticosteroids), hyperse n receive the full service contact Wayne Silverman, PhD, at sitivity to penicillin, a history of significant renal or hepati c 512/926-4900 ext. 120 or vi a email at 22 HerbalGram 54 2002 Clinical Update Herbal Ear Drops Effectively Treat Ear Pain Associated with Acute Otitis Media D eviewed: Sarrell EM , Mandel berg A, Cohen HA. Effi cacy of administered. Ear pain was assessed usi ng the Observational Scale ftnaturopathic extracts in the management of ear pain associat of Behavioral Distress (the Pain-0-Meter). On one side of rhe Pain- ed with acute oriris media. Arch Pediatr Adolesc Med. 200 I 0-Merer are a linear scale (1- 10) and a color scale ranging from 155:796-9. blue (indicating no pain) ro red (indicating the most pain). On rhe Summary: Children ages 6-18 years with a diagnosis of acute oti reverse side of the card is a face scale that is composed of five facial tis media (middle ear infection) and associated ear pain (o talgia) representations ra nging from a broad smile (no pain) to a sad and were recruited for a study comparing the effects of a "naturopathi c" crying child (indicating the worst pain). Entry in the study req uired herbal ear drop product (Otikon Oric Solution, a pain score of at least 3 out of 10 on the linear scale. Healrhy-On Lrd., Perach-Tivka, Israel) wirh standard Success was determined if rhe child had a reduction in anesrheric ear drops (Viramed Pharmaceutical Lrd., ear pain of ar least 75 percent afrer 48 hours and rhere Benyamina, Israel) for rhe symptomatic treatment of was improvement in rhe ch ild's appearance, activity, the ear pain. The herbal ear drops contained a combi and quality of slee p. nation of garlic (Allium sativum L., Liliaceae), mullein One hundred and three children completed the ( Verbascum thapsus L., Scrophulariaceae), calendula (aka marigold, study. Five children we re excl uded due to noncompliance and two Calendula officina/is L. , Asteraceae), and St. John's wort (Hypericum who did not like the smell of the eardrops and refused to have them perforatum L., Clusiaceae) in a base of olive oil (Olea europaea L., administered. Sixty-one children (59.3 percent) received the herbal Oleaceae) (rhe parr of rhe plant used is nor listed in the paper, so it ea r d ro ps and 42 children (40.7 percent) the anesthetic ear drops. is not clear whether mullein leaf or flower was used; traditionally, Compared to base line, children in borh groups had a statistically mullein flower is used for earache and related ailments, rhe leaf for sign ificant (p = 0.007) reduction in ear pain scores. The difference pulmonary indications). The anesthetic drops were a combination in the mean pain levels between the two groups was nor srarisrical of the drugs ametocain and phenazo ne in glycerin. One hundred ly signifi cant, although there was less pain at the 30-minure eval u and ten children were randomized to treatment with either the ation on day I in the group using the herbal ear drops. All children herbal drops or anesthetic drops - five drops to the external canal were effectively treated with the eardrops and there were no of the affected ear observed complications even though sys temic antibiotics were not three times per used. day. C hildren in Comments/Opinions: With an estimated 31 million physician the study received visits reported each yea r, otitis media is the most common condi no antibiotic treat tion in children seen by health care professionals in the United ment. A single States. ' AOM has a peak incidence in children between the ages of dose (15 mg) of 6 and 18 months and, by 7 years, 93 percent of all U.S. children acetaminophen wi ll have had at least one diagnosed episode of AOM.' T he major was administered ity of children with AOM experience an earache. ar the beginning of While antibiotic therapy has become a standard approach to the trial, but par treating AOM, many pediatricians will recommend acetaminophen ents were instruct and/or anesthetic eardrops to reduce ear pain during rhe first few ed to use no other days of the infection. T hese eardrops (s uch as the standard mixture analgesics for the used in this clinical trial) have a localized anesthetic, anti-inflam remainder of the matory, and analgesic action on rhe tympanic membrane (the study. ea rdrum). Additionally, glycerin may decrease middle ear press ure The first data by reducing fluid build-up via os mosis. point (pain scores) Completed by clinical researchers at Tel-Aviv University and the was assessed at the Edith Wolfson Medical Center in Holon, Israel, this study indicates diagnosis of acute that a traditional combination of herbs in an olive oil base is as O titiS media effective as standard anesthetic ear drops in the sy mptomatic treat (AOM). After ment of ear pain associated with AOM. While the results of the instillation of Mullein Verboscum thopsus. study suggest that the herbal ear drops may have been more effec either the herbal Photo © 2002 stevenfostercom ti ve at the 30-minute evaluati on on day I of the study, readers or anestheti c ear should note that acetaminophen absorption rates range from 23 to drops, the patients and parents, under the guidance of the physi 60 minutes.' Considering the initial timing of the single acetamin cian, recorded the pain scores at 15 and 30 minutes following ophen dose, this comparison becomes somewhat cloudy. administration. At days 2 and 3, pain scores we re recorded at home. Pain scores were completed prior to the first dail y administration of While subjective eval uati on of pain was the clear focus of the the eardrops and at 15 and 30 minutes after the eardrops were study, it is unclear how the investigators determined there we re no 2002 HerbaiGram 54 23 Clinical Update complications due to the infection. The researchers correctly point 1992;39: 127-56. out that children older than 6 years old have a greater chance of 3. Watson PO, Mortensen ME. Pharmacokinetics of common anal sponraneous recovery from AOM without using antibiotics. How gesics, anti-inflammatories and antipyretics in children. Clin Phar ever, any practitioner would expect that this be based on follow-up macokinet 1989;17(suppl 1):116-37. 4. Leung A, FosterS. Encyclopedia of Common Natural Ingredients Used evaluation of the child's affected ear and not based solely on subjec in Food, Drugs and Cosmetics, 2nd ed. New York: John Wiley & Sons; tive feedback of patients or parents. In addition to evaluation at 3 1996. p. 113-4. days, follow-up evaluation of the tympanic membrane to rule out 5. Hoffmann D. The Herbal Handbook: A User's Guide to Medical Auid build-up in the middle ear (otitis media with effusion) would Herbalism. Rochester, VT: Healing Arts Press; 1998. p. 67. be critical to determining success with or without antibiotic therapy. 6. Hobbs C. St. John's wort (Hypericum perforatum L.): A review. Herbal Gram 1988/1989; 18/19:24-33. Concerns with study design aside, the clinical trial does provide 7. Hughes BG, Lawson LD. Antimicrobial effects of Allium sativum L. some support for a clinical tool used widely by practitioners of (garlic), Allium ampeloprasum L. (elephant garlic) and Allium cepa L. herbal medicine (including naturopathic physicians and medical (onion), garlic compounds and commercial garlic supplement prod doctors using complementary and alternative therapies) for the ucts. Phytother Res 1991;5:154-8. management of pain associated with AOM. During my seven years of pediatric practice, I frequently recommended that parents administer a similar herbal eardrop preparation (Mullein Garlic Compound, HerbPharm, Williams, Oregon) for children during the first 48 hours of an AOM episode. In addition to the older age group in the Israeli trial, I found the drops to be equally effective for pain reduction in younger children. The upside of the pain reduction was not only happier kids, but also reduced use of aceta minophen (not to mention more relaxed parents). The herbs used in the Israeli product and similar products in the U.S. are based on traditional use. Calendula (marigold) flowers have been traditionally used topically as an anti-inAammatory and for wound healing.4 Mullein Aowers and leaves, because of high mucilage content, act as a demulcent to soothe irritated mucous membranes internally and as an emollient topically to treat skin irritations and minor burns.5 Although more commonly associated Flaxseed Linum usitatissimum. Photo © 2002 stevenfoster.com with its use as an antidepressant, St. John's wort flowering tops have also been used topically to reduce "nerve pain" and inflammation.6 Low-Fat Diet, Supplemented with Garlic bulbs are thought to have topical antimicrobial effects- an action that has been demonstrated in vitro. 7 Flaxseed, May Influence Prostate While the herbal combination used in this trial apparently pro vides symptomatic relief of ear pain associated with AOM, the Cancer Progression investigators in the discussion section of the paper fuel the contro 0 eviewed: Oemark-Wahnefried W, Price DT, Polascik TJ, versy surrounding the rampant use of antibiotics for AOM. The ft.R.obertson CN, Anderson EE, Paulson OF, et aL Pilot study of authors of the study suggest that in children older than 6 years, ini dietary fat restriction and flaxseed supplementation in men with tial antibiotic treatment at the diagnosis of AOM be withheld until prostate cancer before surgery: Exploring the effects on hormonal follow-up (exact amount of time is not given). If no improvement levels, prostate-specific antigen, and histopathologic features. Urol is noted, they suggest then using antibiotics. ogy 2001;58:47-52. Practice Implications: Herbal ear drops containing a combina Summary: In a pilot study, 25 men (average age 64 years) with tion of mullein, calendula (marigold), St. John's wort, and garlic in prostate cancer and awaiting prostatectomy (removal of the prostate an olive oil base may reduce ear pain associated with AOM as effec gland), were instructed to add 30 g (approximately 3 rounded tively as standard anesthetic ear drops. However, recommendation tablespoons) of ground Aaxseed (Linum usitatissimum L., Linaceae) of these drops should be made only following otoscopic examina to their daily diet. Additionally, they were given instructions for a tion of the tympanic membrane and the absence of any rupture that low-fat diet (20 percent of kilocalories or less). Subjects were would allow the drops to enter the middle ear. It should be noted instructed to tally the number of fat grams they consumed each that these drops are only for symptomatic treatment and do not day; however, these did not include fat from high omega-3 fatty exclude the potential need for antibiotic treatment and/or other acid sources such as Aax or fish. Blood was drawn at baseline and supportive therapies. -Donald]. Brown, ND. __.- one to three days before surgery to measure prostate-specific anti Reference: gen (PSA), testosterone, free androgen index, and total serum cho I. Fliss OM, Leiberman A, Draga n R. Medical sequelae and complica lesterol. Following surgery, the tumors of these diet/flaxseed treated tions of acute otitis media. Pediatr Inftct Dis 1994; 13(suppll):S34- men were compared with historic controls (men with prostate S40. tumor removal who did not alter their diet) matched by age, race, 2. Klein JO, Teele OW, Pelron SI. New concepts in otitis media: results biopsy Gleason sum*, and PSA at the time of diagnosis. Tumor tis of the Greater Bosron Otitis Media Study Group. Adv Pediatr sue samples were used to determine the degree of either apoptosis 24 HerbalGram 54 2002 Clinical Update (using a TUNEL score**) or proliferation of the cancer (using a mentation (I 0 g/day for 8 weeks) may inAuence estrogen metabo MIB-1 index**). lism in a way that may decrease risk of breast cancer." Another study The average duration of the diet and Aaxseed supplementation found that lignan levels were higher in the prostatic Auid of men at 3 was 34 days (range of 21 ro 77 days). Compared ro baseline, there low risk of prostate cancer compared ro those at increased risk.' were significant (all p < 0.05) decreases in rota! testosterone (422 + The authors of this study also point ro the high omega-3 fatty 122 ng/dL to 360 + 128 ng/dl), free androgen index (36.3 percent acid content of flaxseed as another potential chemoprotective fac + 18.9 percent to 29.3 percent+ 16.8 percent), and total serum ror. However, this remains somewhat controversial - alpha cholesterol (20 I + 39 mg/dL to 174 + 42 mg/dL). Overall, there linolenic acid (ALA), the most predominant omega-3 fatty acid in were no significant effects on PSA levels. However, using Gleason Aaxseed, has been linked ro increased ri sk of prostate cancer in 4 15 4 sums as a differentiating point, it was found that in men with less some, ' · but not all studies. Although meat is a common source of hisropathologically aggressive disease, the low-fat diet and Aaxseed ALA, the two studies above still found a correlation between supplementation led to slight bur non-significant decrease in PSA prostate cancer and ALA after an adjustment was made for meat levels compared ro hisroric controls. PSA continued ro rise in men intake. While this might not be a concern for ground Aaxseed sup with more aggressive disease. The apoprotic scores (TUNEL scores) plements, it does suggest that men should carefully weigh the risk were significantly different between the two groups (p = 0.0 I) with versus benefits of using Aaxseed oil. a higher score for those in the diet!Aaxseed group. The proliferation Men wishing ro add Aaxseed supplements ro their diet should index (MIB-1 index) was significantly lower for those in the remember that the ground seed has a propensity for rancidity. The diet!Aaxseed group (p = 0.05). Decrease in proliferation and high product used in this study (provided by ENRECO, Inc., of Mani er rates of apoprosis were significantly associated with the number towoc, Wisconsin; trade name is not give n) had added stabilizers, of days on the diet and Aaxseed supplement (p = 0.049 and p = emulsifiers (for ease of mixing), a small amount of oat Aour (to 0.01 7, respectively). reduce the slightly bitter aftertaste of Aaxseed), and was vacuum Commen ts/Opinions: Less an herbal medicine study and more packed. This delivery form made it easier ro sprinkle into cereal or nutritional in scope, this pilot study completed by researchers at mix with juice, yogurt, or applesauce. Duke University provides further evidence that dietary facrors may Practice Implications: Although these data must be viewed as play a role in the progression and possibly prevention of prostate preliminary, the results of this pilot study suggest that a Aaxseed cancer. Some epidemiological studies have linked prostate cancer supplemented, low-fat diet may affect prostate cancer biology, most risk to increased consumption of foods high in saturated fats (pri marily from meat and dairy sources) ' while some,2.3 but not all ,' pre liminary clinical trials have found this link. Full Circle School of Alternative Therapies Typically, as saturated fat is reduced in the diet, most people are likely ro increase fruits and vegetables, which are higher in fiber and other nutrients linked to prostate cancer prevention. Among these are lycopene, a carotenoid abundant in romaroes. 5 Cruciferous veg dba: Yarmony Mountain etables, which are high in substances such as indole-3-carbinol, glu caric acid (calcium D-glucarate), sulforaphane, and the carotenoids Herbal College lutein and zeaxatnhin, have been linked with prostate cancer pre vention in a preliminary study. 6 Other foods linked ro decreased risk of prostate cancer in preliminary research include fish' and soymilk.' 500 hour Botanical Medicine Program Flaxseed is a source of dietary fiber that is especially rich in dietary lignans9 (the authors of this study suggest it has "75 ro 800 times approved and regulated by the more than any other food"). One study found that 50 to 60 g per Colorado Department of Higher Education. day of fiber from mixed sources decreased PSA levels in 14 healthy We are located in the heart of the Colorado men.10 Lignans (typically classified as phytoestrogens) have been found ro inAuence both estrogen and androgen metabolism. " A Rockies and warmly invite all inquiries. study with premenopausal women suggests that Aaxseed supple- Lynn Albers, Program Director This unique Western Herbalism program * Biopsy Gleason su m is a scoring or sum based on tissue biopsy that allows for stagi ng of the disease. The higher the score, the more aggres creates a foundation for a healthier lifestyle sive the disease. and a healthier planet! TUNEL is an abbreviation for terminal deoxynucleotidyl transferase mediated dUTP-biotin ni ck end-labeling and is used to determine an Our next program begins March 27 2002, index of apoptosis. Apoptosis is a type of cell death programmed into a cel l at birth and that triggers its death at old age or under conditions and space is limited! where cell death benefits the host (e.g. ca ncer). MIB-1 is an abbrevia tion for murine MIB-1 hybridoma clone and is used to determine the toll free: 1-877-926-621 0 www.fullcircleschool.com rate of rumor proliferation . 2002 HerbalGram 54 25 ° Clinical Update likely through a hormonal mechanism. This srudy sets the stage for 7. Kune GA. Eating fish protects agai nst some cancers: epidemiologica l larger clinical rrials thar should investigate rhe role of this interven and experimental evidence for a hypothesis [review]. J Nutr Med tion as either (or both) a preventive or complementary therapy for 1990; I: 139-44. 8. Jacobse n BK, Knutsen SF, Fraser GE. Does hi gh soy milk intake prostate cancer. Future trials should also add groups raking only reduce prostate cancer in cidence? The Adventist Health Study (Unit flaxseed w ithout a low-fat diet and a control group using only a ed Stares). Cancer Causes Contro/1998;9:553-7. low-fat diet for comparison. C linicians wishing to recommend this 9. Thompson LU. Flaxseed, lignans, and ca ncer. In: Cunnane SC, regimen for their patients sho uld consider the potential risks of Thompson LU, ed itors. Flaxseed in Human Nutrition. Chicago: drops in serum testosterone levels over a long period of rime (e.g., AOCS Press; 1995. p. 219-36. decreased muscle mass, lowered li bido, depression) as well as the I 0. Tariq N, Jenkins DJA, Vidgen E, er al. Effect of so luble and inso luble difficulry of compliance wirh the diet used in rhis study. fiber diets on serum prostate specific antige n in men. J Urol 2000;163:114-8. -Donald}. Brown, ND. -"' 11. Aldercreurz H , Mousavi Y, Clark J, et al. Dietary phytoestrogens and Reference: ca ncer: in vitro and in vivo srudies. j Steroid Biochem Mol Bioi I. Meyer F, Bairari I, Shadmani R, er al. Dietary far and prostate cancer 1997;4 1:33 1-7. su rviva l. Cancer Causes ControL 1999; I 0:245-51. 12. Haggans C], Travelli EJ, Thomas W, et al. The effect of fl axseed and 2. G iova nnucci E, Rimm EB, Coldirz GA, er al. A prospective srudy of whear bran consumption on urinary estrogen in premenopausal dietary far and risk of prosrare cancer. j Nat! Cancer lnst women. Cancer Epidemiol Biomarkers Prev 2000;9:719-25. 1993;85: 15571-9. 13. Morton MS, Chan PSF, C heng C, er al. Lignans and isoAavonoids in 3. Le Marchand L, Kolonel LN, Wilkens LR, er a!. Animal far co n plasma and prostatic fluid in men: samples from Portuga l, Hong sumption and prostate cancer: a prospective study in Hawaii. Epi Kong, and rhe United Kingdom. Prostate 1997;32: 122-8. demiology 1994;5:276-82. 14. Gann PH , Hennekens C H, Sacks FM, er al. Prospective study of plas 4. Schuurman AG, van den Brandt PA, Doranr E, er al. Association of ma fatty acids and risk of prostate cancer. j Nat! Cancer l nst energy and far inrake with prostate carcinoma risk: results from the 1994;86:281-6. Netherlands Cohorr Study. Cancer 1999;86:1019-27. 15. Giovannucci E, Rimm EB, oldirz GA, er al. A prospective study of 5. G iovannucci E. Tomatoes, tomato-based products, lycopene, and dietary far and ri sk of prostate cancer. J Nat! Cancer lnst ca ncer: rev iew of rhe epidemiologic literarure. J Nat! Cancer lnst 1993;85: 157 1-9. 1999;91 :3 17-3 1. 6. Cohen JH, Krista! AR, Stanford JL. Fruit and vegetable intakes and pros rate cancer risk.} Nat! Cancer lnst 2000;92(1 ):6 1-8. S T E \ ' E N F 0 S T E R G R 0 U P , I N C . ea tured in Herba/Gram for over a decade, the photographs of Steven Foster are available for licensing for editorial or commercial projects. Specializing in medicinal and aromatic plants, our stock photo files include more than 70,000 images, including most major herbs sold as dietary supplements. Steven Foster Group, In c. Ellen Miller, Vice President, Sales and Marketing P.O. Bo x 1343 Fayetteville, AR 72702 501-521-5887 fax 501-521-6369 em a i I: [email protected] www.stevenfoster. com C 0 tv1 E T 0 T I-1 E S 0 U R C E 26 Herba!Gram 54 2002 Columbia University College of Physicians & Surgeons CME Courses 2002 Co-Sponsored by Department of Rehabilitation Medicine The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine April 19 - 20, 2002 New York City ''Integrative Pain Medicine" Course Co-Directors: James N. Dillard, MD and Fredi Kronenberg, PhD Faculty: Rami Burstein, PhD, Harvard Medical School Michael L. Weinberger, MD, Columbia Presbyterian Med Ctr Russell Portenoy, MD, Beth Israel Med Ctr Woodson Merrell, MD, Continuum Ctr Health & Healing Richard Payne, MD, Memorial Sloan Kettering Brian Berman, MD, Univ of Maryland, Program Comp. Med. Nomita Sonty, PhD, Columbia Presbyterian Med Ctr James Dillard, MD, Columbia U., College Physicians & Surgeons David Riley, MD, Univ. of New Mexico Medical School Ken Gorfinkle, PhD, Columbia Presbyterian Med Ctr Christine Wade, Rosenthal Center, Columbia U. Steven Scrivani, MD, DDS, Columbia Presbyterian Med Ctr Joseph Audette, MD, Harvard/Spaulding Hosp. Avital Fast, MD, Albert Einstein Univ. School of Medicine Ruth Fischbach, PhD, Ctr for Study of Society Steven Gurgevich, PhD, Univ of Arizona College of Medicine and Medicine, Columbia Univ. * * * May 20 - 24, 2002 New York City "Botanical Medicine In Modern Clinical Practice" Course Co-Directors: Fredi Kronenberg, PhD and Andrew Wei!, MD Faculty Include: Andrew Weil, MD Michael Balick, PhD, New York Botanical Ga rden Adriane Fugh-Berman, MD Mark Blumenthal, American Botanical Council Tieraona Lowdog, MD Robert McCaleb, Herb Research Foundation Marcey Shapiro, MD Woodson Merrell, MD For More Information and an Application: CME Dept.: (212) 305-3334 http:/ /ColumbiaCME.org http:/ /cpmcnet.columbia.edu/dept/rosenthal! lthough most hea!thcare profess ionals skilled in the art of Additionally, rh e Haida personified bracket fungus as "Fungus botanical medicine are aware of the immune enhancing Man," who, because of his ritual strength, was conscripted by Aproperties of certain mushrooms and other fungi , few may Yaahl, or Raven, as a steersman for his canoe when he went to realize rhar mushrooms are rich sources of natural antibiotics. In obtain female genitalia in the H aida narrative on the origin of these, the cell wall glucans are well-known for their immunomod women. 17 The strong association of rhis fungus with women, in ulatory properties, bur few medical practitioners are aware that particular, and their similarity in form , suggests an underlying many of the externalized secondary metabolites - extracellular female archetype. 2 secretions by the mycelium - combat bacteria '· and viruses. J.6 In a recent in vitro study, ex tracts of more than 75 perce nt of Additionally, rhe exudates from mushroom mycelia are active polypore mushroom species surveyed showed antimicrobial activi against protozoa such as the parasite that causes malaria, Plasmod ty and 45 percent of 204 mushroom species (polypores and gilled 8 ium folciparum/ · and other microorganisms! mushrooms alike) inhibited growth of a wide variety of microor Fungi and animals are more closely related to one another than ganisms. " In particular, this study showed rh ar species in rh e poly either is to plants, diverging from plants more than 460 million pore ge nus Ganoderma such as reishi (G. Lucidum (Curtis: Fr.) P. years ago. '0 Diseases of plants typically do not afflict humans Karst. ), G. pfeiffiri Corner, and G. resinaceum Boud., al l of the whereas diseases of fungi do." Since humans (animals) and fungi family Ganodermaraceae, were specifically effective against bacillus share common microbial antagonists such as Escherichia coli, (Bacillus su btilis). They were not, however, effective against other Staphylococcus aureus, and Pseudomonas aeruginosa, humans can bacteria, including P aeruginosa, Serratia marcescens, S. aureus, benefit from the natural defensive strategies of fungi rhar pro Enterococcus foecium, and Mycobacterium smegmatis. Another duce antibiotics to fight infection from microorgan- study showed rhar rhe artist conk ( Ganoderma isms. H ence, ir is nor surprising our most signif applanatum (Pers.) Pat.) demonstrated antimi icant anti-bacterial antibiotics have been crobial activity against Gram-positive Bacil derived from fungi. 12 Lus cereus, S. aureus, and less acti vity Interes tingly, some mushrooms and agai nst the Gram-negative E. coli, and 19 their components are target-specific P aeruginosa. In contrast, gilled in their antibiotic properties, where- mushrooms such as Psilocybe semi as others have broader effects. lanceata ((Fr.) Quel., Srrophari With an increasing number of aceae), Pleurotus eryngii ((De Can bacteria developing resistance to dolle: Fr.) Quel., Pleurotaceae) commercial antibiotics, such as and Lactarius delicious ((F r. ) S.F. MSRA (methici llin-resistant S. G ray, Russ ul aceae) all strongly aureus) and Pseudomonas, extracts inhibited the growth of S. aureus and derivatives from mushrooms bacteria. hold great promise for novel med Two other mushrooms from the ici nes in modern rimes. The fa mily Polyporaceae are notable hypothesis, increasingly substanti rhe tinder fungus (Fornes fomentar ated, is that mushrooms, especially ius (L.:Fr. ) ] . Kickx.) and rhe birch polypores, provide a protective polypore (Piptoporus betulinus (F r. ) P. immunological shield against a variety of Karst.) - both of which rhe famous 13 5 infectious diseases. ·' 5,300 year old Otzi, or Ice Man, had with Two thousand years have passed since the him when his body was discovered in the high first century Greek physician Dioscorides included alpine mountains on the border of Italy and Aus- the larch polypore (Fomitopsis officinalis (Villars:Fr.) Bond. rria.20 Scientists beli eve his use of these mushrooms was & Singer, Polyporaceae; syn. Laricifomes officinalis (Vi llars:Fr.) likely for their antimicrobial properties" and/or for tinder." The Kodaba & Pouza r) in his De Materia Medica published approxi woody tinder fungus has been shown to inhibit the growth of P mately 65 C.E. Known then as agaricum or agarikon, and later as aeruginosa and S. marcescens, while rhe birch fungus was effective the quinine conk, it was used as a treatment for "consumption," a against these two bacteria, and, further, exhibited strong inhibito disease now known as tuberculosis. The pharmaceutical industry ry acti vity against S. aureus, B. subtilis, and M. smegmatis, a cousin 18 has been slow to explore mushrooms for antibiotic activity, in parr to the pathogenic Mycobacterium tuberculosis. because basidiomycetous fungi are slower growing in fermentation In vitro studies of 26 proprietary cultures of basidiomycetous and less yielding compared to the mold fungi ( such as rhe well mushrooms provided by rhe author found rhar four species "com known Penicillium notatum, the fungus from which Alexander pletely" inhibited E: coli, stopping bacterial growth well in advance Fleming discove red penicillin in 1928.'6 of the encroaching mycelia, suggesti ng an ex tracellular antibiotic.'-' For hundreds of years, the Haida of the Queen Of these four species totally inhibiting E. coli, three C harlotte Islands of British Columbia and other were polypores cloned by the author from the Old Northwest Coast First Peoples have used shelf Drawing of an argillite plate. Growth forests of the Pacific Northwest of polypore fungi medicinally. The Haida carved by Charles Edenshaw in approx. 1890. North America: Ganoderma oregonense gave F officinalis a name that rranslares depicting the Haida myth of the origin of women. Murr., artist conk (G. applanatum), and Fungus Man (Fomitopsis officina/is) is paddling the canoe into "ghost bread" or "tree biscuit." 17 rhe tinder fu ngus (F fomentarius). A with Raven in the bow in search of female genitalia. fourth polypore, turkey rail ( Trametes Shelf fungi were also used spiritually, Diameter = 35 em. Redrawn from a photograph. courtesy versicolor (L.:Fr.) Pilat, Polypo- and were found in shaman graves. of the Field Museum of Natural History. Chicago. 2002 HerbalGram 54 29 A spectacular Chicken-of-the-Woods or Sulphur Tuft (Laetiporus sulphureus. syn. Polyporus sulphureus) specimen col lected from the Soleduck River drainage of the Olympic Peninsula, Washington State. Photo © 200 I by P Stamets raceae), did nor sriAe rhe E. coli remorely, bur irs mycelium con pore fungi validates that this barely explored group, in particular sumed rhe E. coli upon conracr. F fomentarius, as well as orher those with a long history of folkloric use by indigenous peoples, polypores, have ami-viral properries.624·25 A highly warer soluble, should be carefully surveyed.27.28 The brillianrly colored chicken-of low cyroroxic polysaccharopepride (PSP) isolared from T versicol rhe-woods (Laetiporus sulphureus (Bull.:Fr.) Murr., Polyporaceae or has been proposed as an anri-viral agenr inhibiting HIV replica syn. Polyporus sulphureus Bull.:Fr.) produces anribiotics strongly ri on.4 T he facr rh ar mushrooms antagonistic to 5. aureus' 8 and has can have borh anri-viral and ami been noted to consume E. coli upon bacteri al properries, wirh low cyro conracr. 23 Exrracts of cultures of this roxiciry ro animalian hosrs, under mushroom are currently the subject scores rheir usefulness as natural of in vitro scan inves tigations for sources of medicines. anribacterial properries based, in T har rh e Ice Man had rhese poly parr, upon a long history of folkloric 29 pore fungi as componenrs of his use in the Russian Far East. mobile pharmacopoeia srrongly Extracts of shiirake (Lentinula edodes suggests rhar rhese mushrooms (Berk.) Pegler, Polyporaceae) were provided medicine for Paleolithic recently reported to inhibit growth Europea ns, as well as a method ro of S. aureus and E. coli, due in parr to transport and start fire .* Since the formation of oxalic acid, a com auropsies of the Ice Man showed mon crystal on the cellular surfaces he was suffering from inrestinal of the mycelia of many mushroom 30 pathogens, as well as an arrowhead species. Dusty Yao with a 30+ year old Fomitopsis officina/is known to the Greeks imbedded in his shoulder, his pre as ogonkon. a species now nearly extinct in western Europe. Found in an T he Suay et al. study,'" by far rhe sumed use of these mushrooms old growth forest ofWashington State. this mushroom grew downward most extensive to date, also deter appea rs well-warranred. from a fa llen Hemlock tree traversing a w ilderness stream. mined that gilled mushrooms (o rder Photo © 200 I P Stamets Higher concentrations of effec Agaricales) had more species with tive anribacterial agents from poly- antifungal activities rhan did the polypores. The submerged fermentation of rhe mycelium of the • Fomes fomentarius is call ed the tinder fun gus for irs utility in keeping embers ali ve gill ed oysrer mushroom (Pleurotus ostreatus (Jacq.:Fr.) Kumm., for days on end. The mushroom is dried, holl owed our, then stuffed with hot Pleurotaceae) has shown effectiveness against Aspergillus niger;'' embers, and repacked. T he embers co ntinue to burn, slowly, for days. To re- ignite, one of rhe most aggressive of all molds and one of the fungi caus the tinder fungus is uncorked, and the embers are fa nned into flame. Alternately, the dried mushroom ca n be pounded, with the skeletal hyphae dissociatin g, and ing aspergillosis lung disease, a malady rhat can pose a serious becoming a wooly- like mass."' threa r to persons wirh compromised immune systems. Yamabushi- 30 HerbaiGram 54 2002 take (Hericium erinaceus (Bull.:Fr.) Pers. , Hydnaceae) has also aceae), pres umably rich with polysaccharides, retarded C. albi shown anti-fungal activity against the mold A. niger and the yeast cans. " A small study reported that the sy mptoms of 12 of 13 Saccharomyces cervesiae. 32 Additionally, this mushroom is effective women with chronic yeast infections were substantiall y all eviated against aggressive HeLa cells. 33 after a daily consumption of maitake ( Grifola frondosa (Dicks.:Fr.) Not only do the extracellular metabolites inhibit microbes, but S.F. Gray, Polyporaceae) Y T hese studies substantiate that various, so do the heavy molecular weight ce ll -wall polysaccharides. This novel antibiotics from many mushroom species are at play, diverse dual source of anti-microbials enhances the effectiveness of mush and often microbially specific. rooms for medicinal purposes. The polysaccharide lentinan from Medicinal mushrooms have a long and rich hi story of use. More shiitake and schizophyllan from the split-gill polypore (Schizo than 2,000 years ago, Dioscorides knew that F officina/is fought phyllum commune (L.) Fr., Schizophylaceae) inhibit Candida albi "consu mption;" the Ice Man had F fomentarius and P betulin us with cans and 5. aureus. 34 Lentinan is also effective in retarding Mycobac him; and the healers-even shamans of Paleolithic peoples- knew terium tuberculosis and Listeria monocytogenesu while an extract of and used mushrooms as powerful medicin es to fight illnesses. In the the mycelium was active against herpes simplex virus type 1 (HSV- world of the pre-modern shaman, spirits caused diseases, and medic 1). 35 Mushroom polysaccharides such as lentinan can enhance the inal compounds were administered to appease or treat them. immune system, potentiating a host-mediated response, and indi Although science now knows that pathogeni c microorganisms cause rectly, but effectively, may be amimicrobiaJ.3'··" many diseases, it is not known whether Paleolithic peoples had an The well-studied polysaccharide PSK from turkey tail ( T versi intuitive or specifi c knowledge of the nature of infection from 4 microbes. Whether disease is caused by "spirits" or invisible color) also inhibits the growth of C. albicans.'"· ' Simple hot-water ex tracts of the blewitt (Lepista nuda (Bull. ) Cooke, Tricholomat- microbes, both views hold in common an underl ying cause of the unseen universe. '7 In the future that shared vision may extend to Cross-Index of Mushrooms and Targeted Therapeutic Effects Species Abbreviations (for full species names, see Key Guide below) Ab Cs Ff Fv Ga Gf Gl Go He lo Le Ls PI Po Pu Sc Tv anti-bacterial • • • • • • • • • • • • • • anti-candida • • • anti-inflammatory • • • • • • antioxidant • • anti-tumor • • • • • • • • • • • • • • anti-viral • • • • • • • • • • • blood pressure • • • • • blood sugar moderating • • • • • cardio-vascular • • • • cholesterol reducing • • • • • • • immune enhancer • • • • • • • • • • kidney tonic • • • • liver tonic • • • • • • lungs/respiratory • • • • • • nerve tonic • • • • • sexual potentiator • • stress reducing • • • • Key Codes to Medicinal Mushroom Species Ab Agaricus blazei (Royal Sun Agaricus) Go Ganoderma oregonense PI Phellinus linteus (Meshimakobu) Cs Cordyceps sinensis ( Cordyceps) (Oregon ganoderma) Po Pleurotus ostreatus (Oyster) Ff Fames fomentarius (Tinder fungus) He Hericium erinaceus (Yamabushitake) Pu Polyporus umbellatus (Zhu ling) Fv Flammulina velutipes (Enoki) lo lnonotus obliquus (Chaga) Sc Schizophyllum commune Ga Ganoderma applanatum (Artist Conk) Le Lentinula edodes (Shi itake) (Split-gill Polypore or Suehirotake) Gf Grifola frondosa (Maitake) Ls Laetiporus sulphureus (Chicken-of-the- Tv Trametes versicolor (Turkey Tail Gl Ganoderma lucidum (Reishi) Woods or Sulphur Tuft) orYun Zhi) © Pau l Stamets, all rights reserved. Do not duplicate without permission. Source: Supporting reference information at 2002 HerbalGram 54 31 using the same tools as a practical treatment 11 . Martin G. Nature's pharmacy: mushroom for microbial infection. proponent finds interesting rising; many germ-busting fungi hold promise for medi The mushroom genome stands out as a cine. San Francisco ChronicLe. 2001 Nov 25. virtually untapped resource for novel anti 12. Hardman, A, Limbird L, Goodman G ill microbials. The declining ancestral forests man A. (edirors) The Pharmacological Basis of the Pacific Northwest harbor novel of Therapeutics, Tenrh Edition. New York: mushroom species and strains that occur McGraw-Hill; 200 I. nowhere else in the world. Focusing on 13. C hihara G. Immunopharmacology oflenti these fungi may lead to novel myco-medi nan, a polysaccharide iso lated from Lenti nus edodes: Irs application as a host defense cines, hopefully before the opportunity is potenriaro r. International journal of Orien forever lost as old growth temperate rain ta/Medicine. 1992;17:55-77. forests are converted into tree plantations. A 14. Hobbs C. M edicinal Mushrooms. Loveland rich fungal genome is an essential compo (CO): Inrerweave Press; 1986. nent of our natural heritage and may be 15. Mizuno T, Sairo H , Nishiroba T, Kawagishi society's greatest protection against micro H . Antitumor active substances from mush bial diseases. The intelligent use of these rooms. Food Reviews International. fungi can potentiate the host defenses of 1995;111: 23-61. 16. Jacobs F. Breakthrough: The True Story of both people and planet. --"' Once thought by anthropologists to be made from Penicillin. New York: Dodd, Mead & Com Acknowledgments: The author thanks wood, this "Grave Guardian," was carved from Fomi pany; 1985. Andrew Wei!, M .D.; Donald Abrams, M.D.; topsis officina/is, and "placed upon graves to protect 17. Blanchette RA , Compron BD, Turner NJ, Reinhold Poder, Ph.D.; Christopher Hobbs, the shaman during his long death slee p." Dims: 16cm Gilbertso n RL. Nineteenth ce ntury shaman L.Ac., AHG; Dusty Ytto; Frank Pirano, Ph.D .; L x I I em W x 19cm H. Collected from Augoon, grave guardians are carved Fomitopsis offici Alaska, by Emmons in 1902; now located at the Solomon \Vtzsser, Ph.D.; and the p eer reviewers na/is sporophores . Mycologia. American Museum of Natural History, New York 1992;84(1):1 19-24. ofHerbalGram. (Ell 044). Photo courtesy of R. Blanchette. 18. Suay I, Arena! F, Asenio F, Basilio A, Cabel Paul Stamets is the author of five books, lo M, Diez MT, et al. Screening of basid including Growing Gourmet & Medicinal Mushrooms, a mush iomycetes for antimicrobial acti vities. room cultivation textbook used worldwide. On the editorial boards of Antonie van Leeuwenhoek. 2000;78:129-39. the International Journal of Medicinal Mushrooms and Mush 19. Smania A, Monache FD, Loguericio-Leite C, Smania EFA, Gerber AL. Antimicrobial activi ry of bas idiomycetes. International journal of room, the Journal, he also serves as an advisor to the Program for Medicinal M ushrooms. 200 I ;3:87. Integrative Medicine, University ofArizona. His company, Fungi Per 20. Peintner U, Poder R, Pumpel T. The Ice Man's fungi. Mycological foeti, purveys Certified O rganic materials to grow gourmet and medic Research 1998; 102:1153-62. inal mushrooms for p ersonal use or professional cultivation. He may be 21. Capasso L. 5300 years ago the Ice Man used natural laxatives and reached by email at 32 Herba!Gram 54 2002 Ice Man's Medicine Kit he discovery of the mummi Tfied human body known as the "Ice Man" in a glacier in rhe Italian Alps in September 1991 caused great excitement in the scientific world. Luigi Capasso, an anthropologist at the National Archeological Museum in Chieti, Italy, reported in The Lancet that the two walnut-sized lumps car ried by this individual have been identified as the woody fruit of Piptoporus betulinus, a bracket Otzi or the Ice Man, who fungus common in alpine and used mushrooms more than other cold environments. p 5,000 years ago. betulinus contains toxic resins and an active compound, agaric acid, which are power ful purgatives and result in bouts of diarrhea. The fun gus also contains oils that are toxic tO metazoans and have antibiotic properties, acting against mycobacteria. Says Dr. Capasso, "An analysis of the content of the Steve Cividanes with a 35-year-old Artist Conk or Kofukisaruno Koshikake Ice Man's rec (Gonodermo opplonotum) growing from an Old Growth conifer tree in the tum revealed Duckabush River drainage of the Olympic Peninsu la. Photo © 200 I P Stamets Trichuris 32. Okamoto, K. Antimicrobial chlorinated orcinol deri va tives from michiura eggs, mycelia of Hericium erinaceum. Phytochemistry. 1994;34(5) :1 445-6. which cause a 33. Kawagishi H , Ojima F, Okamoto K, Sakamaro H , Ishiguro Y. condition that Cyathane deri vatives and antimicrobial agents containing same, 1995 might have U.S. Patent No. 5,391 ,544. progressed 34. Wasser AL, Weis AL. Medicinal properties of substances occurring in without symp- higher basidiomycetes mushrooms: current perspectives (Review). toms, but The "wooly mass" in possession of the Ice Man. InternationaL journaL ofMedicinaL Mushrooms. 1999; 1:31-62. Made from Fornes fomentarius, the hardened 35. Sarkar S, Koga J, Whirley RJ , C hatterjee S. Antiviral effect of the more likely wood conk is first moistened, and then pounded extract of cul ture medium of Lentinus edodes mycelia on the replication resulted in abdominal until the hyphae separate. This material is highly of herpes simplex virus 1. AntiviraLRes. 1993;20(4):293-303. flammable, and can be woven into garments. 36. Aoki T. Lenrinan. In Immune Modulation Agents and Their Mecha pain and cyclic nisms. Femchel RL, C hirgis MA (editors) . Immunology Studies. anemia." 1984;25:62-77. Ice Man may have been aware of his intestinal parasites 37. Kanai K, Kondo E. lmmunomodulating acti vity oflentinan as demon strated by frequency limitation effect on post-chemotherapy relapse in and fought them with possibly the only remedy then ex perimental mouse tuberculosis. In Manipulation of Host Defense available in Europe Mechanisms. Aoki T. et al. (editors). Amsterdam: Excerpta Medico measured doses of P (International Congress Series 576); 198 1. betulinus. A 38. Yokota M . Endotoxemia is masked in fungal infection due to enhanced - BarbaraA. endotoxin clearance by beta-glucan. Int. Surg. 199 1;7 6:255-60. 39. Tsukagoshi S, H ashimoto Y, Fujii G , Kobayashi H , Nomoro K, Orita johnston K. Krestin (PSK). Cancer Treat Rev. 1984; 11:1 3 1-55. [Wilford JN. Lessons in 40. Sakagami H , Aoki T, Simpson A, Tanuma SI. Induction of Iceman's Prehisroric Med immunopotentiation activity by a protein-bound polysaccharide, PSK. icine Kit. New York Times Anticancer Res. 199 1; II :993-1000. Science. December 8, 4 1. Sakagami H , Takeda M. Diverse biological activity of PSK (Krestin), a 1998. protein-bound polysaccharide from Coriolus versicolor (Fr.) Que!. Pro Capasso L. 5300 years ago, the Ice Man used ceedings of the First International Confe rence on Mushroom Biology The Birch Polypore (Piptoporus bewlinus) natural laxatives and and Mushroom Products. 1993 August 23-26. The C hinese University is thought by many to have been used as of Hong Kong. Mushroom Biology and Mushroom Products. Chang ST an anti-microbial agent. antibiotics. Lancet. 1998;352: 1864.] et al (editors). Shatin, Hong Kong: C hinese Un iversity Press; 237-45. Photos above © 1998 R. Poder 42. Altshul S. Mushroom remedy for chronic yeast infections. Prevention Magazine. 2001 Nov I ;53(11 ):60. 2002 HerbalGram 54 33 Ginseng Panax ginseng. Courtesy of Korea Office of Monopoly, Seoul, Korea. The Nature of Ginseng Traditional Use, Modern Research, and the Question of Dosage he way in which ginseng is used depends on one's views Ginseng in Traditional Chinese Literature regarding its indications, effects, and proper dosage. Fre Ginseng was originally used as an herbal medicine in ancient T quently, the views expressed in today's popular literature China, and there are written records for its use going back to about about ginseng reAect neither the traditional use of the 100 C. E. The body of traditional Chinese medical liter herb throughout Chinese history nor the current con V)' Sublmti ature is an important resource for understanding gin sensus of scientific knowledge about ginseng and its Dharma wmd a, seng because virtually all contemporary proponents of active constituents. Further, ginseng research is of vary Ph.D. ginseng refer to the herb's long history of use in China ing quality and the results can be misleading if study as a reason to recommend its use as a health product. design and reporting are not critically analyzed before T he designs of modern scientific investigations of gin accepting the conclusions offered by the authors. This article seng are usually aimed at attempting to confirm the validity of the reviews both the traditional use and evolving modern interpreta traditional uses. Thus, the historical basis for the indications, tions of ginseng. This information may aid consumers in deriving dosage, and duration of use of the herb is still relevant. the most benefit from the herb and its products. In particular, the The basic framework of the Chinese culture coalesced around a recommended dosage of ginseng is considered because of signifi group of ideas and practices that were introduced during the peri cant differences between Asian and Western suggestions. od 500 B. C.E. to about 200 B. C.E. Essential contributions included 34 HerbalGram 54 2002 developmenr of the writing system based on ideographic charac of herbs he tasted, 360 were dee med suitable (nor roo poisonous, ters; inrroducrion of the basic Chinese philosophical systems bur having a nature and taste that would impart medicinal effec derived from the trio of Confucianism, Taoism, and Buddhism; tiveness) for inclusion in this text. This book, a translation of solidification of rhe organizing principles of Yin and Yang and the which is now available, ' includes the first written record of ginseng Five Elemenrs in observation of natural phenomena; evolution of as a medicinal agent. The use of ginseng in China, and, indeed, the medical system incorporating acupuncture and complex herbal throughout As ia, is based largely on the description in this book, a formulas; and institution of the Imperial governmenr system. description that has been passed on from generation to generation Then, during the Han Dynasty (203 B.C. E. ro 220 C.E.), these crit since that rime. The Chinese medical system is highly conse rvative: ical cultural developments were for- rather than seeking out innovations, malized and the derails were recorded physicians and scholars constantly for posterity. Any investigation of the strive to stay true to the original. origin of a fundamental Chinese con Thus, it is essential to know the clas cept, such as the meaning and va lue sical understanding of ginseng to of ginseng, begins with a study of this grasp irs meaning in subsequent ce n period; the beginnings of ginseng use runes. and the description of its effects can Traditional Chinese Medicine be traced by examining the written Concepts records. Each herb in Shennong's herb The oldest medical document of guide is described by only a few sen C hina, buried around 170 B.C.E., tences rh ar, despite their brevity, con during the early Han Dynasty, was vey much to the traditional physi excavated from a tomb in 1973 at cians. In order to understand the text Mawangdui, the "mounds of the on ginseng, one must be familiar with horse emperor," near Changsha, the the two basic descriptive categories capital of Hunan Province in central for herbs in traditional C hinese med China.' This record suggests that the ici ne - nature and tmte (see related traditional Chinese medical system article, page 42). was still forming at that rime, and had not ye t reached the relatively The Shennong Bencao Jing says this consistent set of theories and rules about ginseng: ' that emerged soon after. For example, Ginseng [renshen] is sweet and a the system of meridians, rhe channels little cold. It mainly supplements of the human body that became a the five viscera. lr quiets the essence central component of the acupunc spirit, settles the ethereal and cor ture system, was different at this time. poreal souls, checks fright palpita A sc roll listing herb formulas, the 'i tions, eliminates evi l qi, brightens 1 Wushier Bingfong (Prescriptions for 52 the eyes, opens rh e heart, and Diseases), dared 300-200 B.C.E., sharpens the wits. Protracted rak reveals that the early Chinese herb ing may make the body light and prolong life. Its other name is renx formulas usually employed two to Asian Ginseng Ponox gmseng. lllustr·ation by Yue-ming Chen: courtesy three ingredients, compared to the of World Life Research Institute. Colton. California. ian. Yet another name is guigai. It more complex formulas containing grows in mountains and va ll eys. from six to fifteen herbs used today. In addition to translating Chinese characters into Engl ish words, Apparently, ginseng is nor included in these ea rly formulas.' several other concepts in derail to help the reader ap preciate fully The text that serves as the key source book for all of Chinese the ancient description of ginseng are explained: medicine, the one to which every phys ician refers for wise sayings • Ginseng is sweet. Anyone who tastes a ginseng root today will of unquestionable authority, is the Huangdi Neijing, or the Yellow find it quire bitter. The freshly picked root is sweeter (has a Emperor's Classic ofMedicine. 3 Based on the writing style and refer somewhat pleasa nt taste compared to many other herbs), bur, ences to various cultural matters, this book is believed to have been more importantly, the designation of the root as sweet is part written between 100 B.C. E. and 100 C. E. (the middle phase of the ly based on the idea that sweet is the underlyi ng inherent taste Han D ynasty). It describes the cause and development of diseases, within the herb that reflects irs actions. Like other sweet and depicts some acupuncture therapies for them. Herbs are bare herbs, it is believed that ginseng wi ll tonify the spleen, calm ly mentioned, and only in a general way, without reference to spe irritation, and nourish the body. Later Chinese texts often cific herbs. Ginseng is not mentioned. mention the bitter taste as well. The first book that serves as a compendium of herbal knowledge • a little cold: The action of the herb is rel atively mild, in con for the Chinese tradition is the Shennong Bencao }ing or rhe Clas trast to a cold herb, but its nature is still like that of a cold sic Herbal of Shennong, written around 100 C. E. Shennong was a herb, able to all eviate hear sy ndromes. The combination of mythological figure, the divine farmer, who was said to have tast sweet and cold together has the effect of calming nervous agi ed 70 different herbs each day, determining whi ch ones were use tation; the sweetness alleviates irritation and the coldness ful for humans and the properties of those few. Of the thousands calms the internal fire that agitates the human spirit. 2002 Herba!Gram 54 35 supplements the five viscera: G inse ng does something dim, then a person's fundamental nature will be pre more than most of the sweet herbs; it not only benefits vented fro m attaining irs ultimate ex pression: the person the spleen, but also the other four sys tems of the body. will be timid, unhappy, eve n depressed. When the heart One implication is that ginseng greatly improves the opens and the mind quiets, the nature will be expressed ability of the spleen, one of the five fundamental viscera, and the perso n will display sure purpose, will, and to draw nutrients out of food and distribute them to the courage, able to accomplish great things . other orga ns. It serves as a nutritive aid, bur does not • protracted taking may make the body light and prolong life. provide nutrients. This phrase is included in reference to the intensive • quiets the essence spirit. The essence spirit (jingshen) , can efforts undertaken by Taoists pursuing immortality dur be broadly interpreted as referring to the mind. Thus, ing the H an Dynasty period. T hey believed that one ginse ng quiets the mind. By taking could shed the phys ical body and float ginse ng, excessive mental chattering into the heavens as an immortal being. calms down. Most of this transformati ve (alchemical) • settles the ethereal and corporeal souls: process was accomplished with minerals, The ethereal soul (hun) and corpore such as cinnabar (mercury sulfide), al soul (po) refer to fundamental which, is known now, slowly poisoned fo rces within the body. T he ethereal the Taoists' bodies due to prolonged soul is believed to reside in the liver exposure. One consequence was that and to be responsible for dreams; the they lost weight: at the time, their unse ttled hun causes one to have dis shrinking fl es h was taken not as an indi turbing dreams, even nightmares. cation of poisoning, but as a sign that The corporeal soul is said to reside they were shedding their earthly body to in the lungs, and to be responsible leave only th e heave nly body. T his sec for maintaining the integri ty of the tion does not indicate that ginseng can physical body. Persons who develop be used as a weight loss herb for the life-long degenerative diseases are obese, nor does it even suggest that one said to suffer from scattering, often can live longer on this earth by taking the the res ult of being fri ghtened, of the herb regularly; it refers specifically to the corporeal soul. It could be said that Taoist concept of transformation to an ginseng calms the distressed mind ethereal immortal. while strengthening the body. T he Shennong Bencao j ing does not • checks fright palpitations: When a record anything about how to use gin person is fri ghtened, he/she experi- Korean Ginseng Panax ginseng. se ng (e.g., dosage, preparati on, duration ences an irregul ar heartbeat. Persis- Photo © 2002 stevenfostercom of use), bur only presents its nature, taste, tent fearfulness and wo rry - that and effects. There were few references come from having bee n frightened anywhere in the book to how long one - will cause occasional heart palpitations; anxiety would use an herb, though the implications we re that the attacks and pani c attacks correspond roughly to fright more roxie herbs had to be used onl y briefly whereas the less palpitati ons. Ginseng helps calm the heart (the res ting roxie ones (s uch as ginseng, bur al so cinnabar, which was not place of the spirit) so that it does not overly react to deemed toxic at the time) could be used over a longe r period ex ternal stimuli nor to intern al mental worries: equa of rime. nimity is restored. Medicinal Use of Ginseng in Ancient • eliminates evil qi: Evil qi refers to influences from the Chinese Medicine envi ro nment that cause diseases. Herbs that nourish the The first book that describes with some details the actual viscera, li ke ginseng, are usuall y not attributed the abil medical applica tions of herbs is the Shanghan Lun, or the ity to ex pel the evil that is causing disease; more often, Treatise on Treatment of D iseases Induced by Cold (Lun is a such herbs are said to protect the body from evil qi (evil treatise or discuss ion; Shanghan was a disease category cannot get into the strong and well-nourished body to depicted in the Yellow Emp eror's Classic, involving a se ri ous cause disease) or to help the body recover its strength illness initiated by cold evils). That text was written at the once the evil has been eliminated. This property of the end of the H an Dynasty (around 220 C. E.) and is still stud herb means that ginse ng can be taken when a disease is ied carefully today by all who practi ce traditional Chinese present to help cure it. Some later authorities dis medicine. Throughout the history of Chinese medicine, agreed wi th this view and sugges ted that ginseng had scholars have cautioned phys icians repea tedly to study and only tonic properties and should not be taken while pay attention to the formulas mentioned in this text, and to evil qi was still prese nt. avo id straying roo far from the principles described therein. • brightens the eyes, op ens the heart, and sharpens the T here are at least three English translations currently avail wits: T he eyes are the windows to the mind; the heart able, of which the one by H su and Peacher' is recommended is the res idence of the mind, and the wits are the because of their attempts to stay true to the original by using express ion of the mind. T his section says that by taking an old version of the text for translation: a reprint of one first ginse ng one's mind will not become dull. If the heart published in 1060 C.E., during the Song Dynasty (960- 1279 becomes closed, if the mind becomes overwhelmed with C.E.) . At that rime, the Shanghan Lun was divided in to two thoughts, if the spirit is clouded and the eyes therefore books, the first carrying the original title and the second 36 HerbaiGram 54 2002 give n a separate ririe: jingui Yao fue, or the millions at C hinese parent medicine Prescriptions of the Golden Cabinet, he question of how much fac tories, such as Beijing's To ng Ren which H su has also translated. ' T ginseng to take in order Tang, founded in 1669 C.E. (during T he Shanghan Lun presents 107 for to gain its purported beneficial the Qing Dynasty), one of the mulas that had been coll ected by rh e effects is one that is important larges t of rh e hundreds of such factories in modern C hina. phys ician Zhang Z hongjing. G inse ng to the modern situation where is an ingredient in 2 1 of the formulas, T he pill, as described above, clea rly being an important herb. One recommendations vary widely. has about 1. 5 grams of gin of the representati ve formulas contain seng and the dail y dose ranges ing ginse ng is call ed Lizhong Wan, or fro m 1-4 pill s, o r 1. 5-6.0 rhe Pill to Recti fy the Center. H ere, "rh e center" refers to the grams of ginseng. Fo r other ginseng-containing for spleen sys tem, and what is being rectified is irs disturbance, mulas in the Shanghan Lun rh ar are made in decocti on marked by upper abdominal disco mfort, accompanied by rather than pill form, the ginse ng dosage is about 1. 3-3.9 diges tive sys tem disorders such as loss of appetite, nausea, grams. Thus, the range of dail y ginseng doses reported was burping, vomiting, or diarrhea. ["Spleen" in traditional Chi from as little as 1. 3 grams for a single dose, to as much as 6.0 nese medicine refers, in parr, to the digesti ve tract, not the grams for a double dose (as might be needed in so me cases) . specific anatomical organ called the spleen in Wes tern med T he ginse ng in use at this time (e nd of the H an Dynasty), icine.] In this text, the cause of the disease is thought to be and for centuries afterward (to the end of the Ming Dynasty, excess ive cold (a type of evil q1) in the environment. After 1644 C.E.), was al l wild ginseng. Ginseng hunters would entering rhe body, if the evil qi has not been dispell ed, it pen search through the fores ts of northeastern C hina to find rhe etrates to the interior and damages the functi on of the plants, carefully remove them fro m the soil , d ry them, and splee n. The formula is said to d ri ve out this evil coldness. bring them to rh e herbal ists who, for rh e most parr, we re T he formula contains equal parts of four herbs: Asian gin working further south. Modern proponents of ginseng have se ng (Panax ginsengC.A. Mey., Arali aceae) root, ginger (Zin argued that wild ginseng is much more potent than the culti giber officina fe Roscoe, Zingiberaceae) rhizo me, C hinese va ted type. If this is the case (a nd it has not been confirmed), li corice ( Glycyrrhiza uralensis Fisch. ex D C., Fabaceae) root, then the dosage of cultiva ted ginse ng to be used today, in a and bai-zhu atractylodes (Atracty fodes macrocephala Koidz., similar applicati on to the ancient uses, might be eve n hi gher As teraceae) rhizo me. T he first three herbs are fa miliar to than that described above for the wi ld-harvested roots. most people with even a small knowl edge of C hinese herbs; Unfortunately, wild ginse ng pl ants do not fl ourish under bai-zhu atractylodes is commonly used in C hina for treating press ure of coll ecti on because of limited seed germinati on diges ti ve sys tem disorders. T he herbs are prepared as a pill and slow maturati on. As a res ul t, rh e supplies of ginseng in (wan) . The intended C hina graduall y effect of taking the receded to the regions formula is to feel that were increasingly warmth in the inaccess ible in the far abdomen (this effect no rtheastern moun comes mainly fro m rains. T he ability of the ginger). If that herbalists to obtain warmth is not felt, ginse ng decl ined, and one can increase the the cost increased, dosage from 1-2 pills making it available to 3-4 pills. Alterna only to those who tively, the herbs can be were wealthy. Despite decocted (put in water irs increasing rarity, that is then boiled). ginseng was still men T he entire batch of tioned in rhe C hinese tea is taken in one day. medical literature dur T he ques ti o n of mg rh e centuries how much ginse ng to when it was rare, and take in order to gain Red Asian Ginseng Panax g1nseng. Photo © 2002 stevenfoste1~com used in fo rmulas to irs purported benefi treat va ri ous ailments, cial effe cts is one that is important to the modern situation especiall y those of the where recommendations vary widely. Es timates of ginseng diges ti ve system. Pe rhaps one of the most fa mous of all the dosage in its traditional applicati ons can be deri ved from the ginse ng-contai ni ng form ulas (at least, of those in whi ch gin ancient texts, such as the Shanghan Lun. T he instructions for se ng is a primary ingredient) was record ed in an Imperi al preparing Lizhong ~n are as follows: grind the herbs to herb formula guide of the Song Dynasty (960- 1279 C.E.) . powder; mix them with honey; and then form pills the size T he formula, ca ll ed Si j unzi Tang, or rh e Four Gentleman of an egg yo lk. Such pills are quite large, typically weighing Decoction, was record ed in rh e Taiping Huimin Hejiju Fang about 9 grams, of which about 6 grams comes from the herbs (Formulary of the People's Benevolent Pharmacy of the Taiping and 3 grams from honey. They cannot be swallowed whole, Era). This tex t, published in 111 0 C. E., described fo rmulas but are chewed up or added to hot water, dissolved, and con made ar the Imperial pharmacy. It is the source of many of sumed as a tea. This same type of pill is produced today by rh e formulas used today, es pecially the traditional formulas 2002 HerbalGram 54 37 manufactured in C hinese parent med enough rest, and anxiously worrying inseng was given mainly icine facrories as pills. instead of devoting oneself ro essential for syndromes that T he formula is almost the same as G tasks. The larrer is des igned fo r rhose Lizhong Wan, illusrraring the srabili ry involved digestive system who suffer fro m mental agitation, anx of herbal formulation patterns over rhe weakness .. . iery, and insomnia. When prepared as a cenruries. There is substitution of o ne decoction, the ginseng dosage in the herb: ginger is deleted and replaced by former is 9-12 grams and, in the latter, the fungus call ed Julingo r poria ( Wolfiporia cocos (F.A. Wolf) 3-6 grams.' Ryvarden & Gilb., Polyporaceae, syn. Poria cocos F.A. Wolf). In sum, ginseng was given mainly for syndromes that Un li ke Lizhong Wan, which is intended ro warm up the in volved digestive system weakness and the dosage of ginseng abdomen with rhe spicy warming herb ginger, Si }unzi Tang ranged from about 3-9 grams in most instances, with low is supposed ro help ass u re rhar rhe water ingested, both as dose adminisrratio n of about 1. 3 grams and high dose beverage and as the moist parr of food, is extracted and cir administrati o n of up to 12 grams. The modern C hinese culated (failure ro do so leads ro loose srool o r diarrhea). materia medica guides for use of ginseng are in agreemenr Poria is a bland tasting and neutral herb that is reputed ro w ith these amounts, namely a daily dose of 3-9 grams for soak up and redisrribute moisture. standard appli cations."·" This formula is reponed in every modern text on tradi T he duration of using ginseng, alone or in formulas, was tional C hinese herbal formulas; it is USLial!y the first o ne list not specified in the early texts. In some instances, it was ed in rhe section devoted ro qi tonic formulas. A rypical understood that only one or two doses would be enough to dosage pattern fo r Si }unzi Tang is:6 change the course of a disease and help the patient onto the Asian ginseng I 0 grams path ro recovery. In other situatio ns, ir was undersrood rhat ginseng would be taken for many days ro change a persisrenr Bai-zhu arracrylodes (Atractylodes macrocephala Koidz., pattern of imbalance. Due ro rhe rariry and high cost of gin Asteraceae) 9 grams seng, it was usually used o nly so lo ng as deemed absolutely Poria 9 grams necessary. T he Taoists who rook ginseng daily to become C hinese licorice, baked ( Glycyrrhiza uralensis Fisch. ex immortal coll ected their own herbs to pursue their goals. DC, Fabaceae) 6 grams Updating the Concept of Ginseng T he dosage of ginseng in th is fo rmula is representative of T he first known treatise devoted specifi call y ro ginseng was the amounts used when ginseng is considered a major con written during rhe 16th century C.E. (Ming Dynasry). triburor ro a formula. In some other texts, as summa ri zed in Excerpts of it appeared in a book that remained essential to Chinese Herbal Medicine Formulas and Strategies,' a leading Chinese herbalism for the next four centuries and even guide for modern practitioners of TCM, the dosage of the today: Bencao Gangmu (Great Compendium of Herbs). The herbs for this formula is lower; ginseng is administered at author of Bencao Gangmu, Li Shizhen, is revered to this day 3-9 grams. for his efforts to organize herbal knowledge and sort through There are two other famous prescriptions with gi nseng rhar rhe growing morass of misinformation that had developed deserve special mention. These were also formulated during after rhe Song Dynasry period. The ginseng treatise had been the Song D ynasry: Buzhong Yiqi Tang (Decoction for Toni written by his father, Li Yenwen, and this parr was published Eying rhe Center and Regulating the Qi, from a book pub in the Bencao Gangmu in 1596:'0 lished in 1249 C.E.) Used fresh, ginseng displays a cool nature. When it is and Guipi Tang used after preparation [steamed, red ginseng], its nature (Decoction for is warm. T he sl ight sweet taste strengthens rhe yang, the Restoring the somewhat bitter taste strengthens the yin. Nature [xiniJ Spleen; from a book controls the genesis of things: their origin is in heaven; published in 1253 tastes control the completion of things; their origin is in C.E.). Both prescrip the earth. Nature and taste, genesis and completion are tions are used ro aid realizati ons of yin and yang. T he cool nature of fresh the digestive func ginseng expresses the yang influence of spring, namely, tions. The former is of genesis and development. T his is the yang of heaven. usually selected for It has the nature of rising. Sweet is a taste that has been those who h ave formed through transformation of moisture and earth. been debilitat These are the yang influences of earth. T hey have the ed by pro nature of floating. T he somewhat bitter taste has been longed ill formed through reciprocal interaction of fire and earrh. ness, espe These are the yin influences of earrh. They h ave the c i a I I y nature of descending in the body. wh en the Taste and nature are both equally weak in ginseng. illness has Whatever has a weak nature descends in the body when come about fresh, and rises when prepared. Whatever has a weak poor taste rises in rhe body when fresh and descends when habits: eating irreg prepared. In case of illness in which the earth [spleen] ularly, working roo Asian ginseng Panax g1nseng. shows a depletion and the fire [hearr] shows vigor, the hard without Photo © 2002 stevenfosteccom 38 HerbaiGram 54 2002 weak cool nature of fres h ginseng and return the dead to life. Wealthy is suited to diminish the blazing of eclining wild resources of families would squander their life sav the fire and to replenish the earth. D ginseng eventually led to ings on ginseng roots to save a dying This could be called a pure use of considerable distortions in family member. When ginseng gmseng's nature. failed to accomplish irs claimed concepts about the nature of In the case of ill ness characterized revival and the person died, by depletion in the earth and weak ginseng and how it could be gmseng was sometimes ness in the lung, the sweet taste and used. Ginseng sellers exagger blamed for rhe death. H ence, warm nature of prepared ginseng is ated the benefits of the herb ginseng gained a reputati o n as a highly dangerous herb: o ne suited to replenish the earth and to to justify the increasing price. generate the metal [associated with that could save lives or snuff lung]. This could be call ed a pure them our. All depended on usi ng it use of ginseng's taste. correctl y; a misdiagnosis and in appro priate prescription for these term inall y ill parienrs would be One can rake from this description rhar Asian gmseng, quickly fatal. The underlying concept, including both rhe whether "fresh" (indicating rhar it is nor processed ; i.e. , versatility of ginseng and an allusion to dire consequences, dried, white ginseng) or prepared (i. e., steamed ginseng, was described by Xu Dachun" in his brief essay on ginseng which usually turns red in color), has a mild quality and ( 1757 C. E., during the Qing Dynasty): effect: both irs nature and taste are weak. The author is illus trating that ginseng can both float and sink in the body (irs Since ginse ng is a substance ri ch in influences [qt] and taste working in one direction and irs nature in rhe other), full of vigor [able to affect all pans of rhe body], iris able mea ning that it can be used in treating ailments affecting to supplement depletion and stop rhe loss of proper both the upper and lower body. influences, no matter whether a patient's illness is relat- ed to wind, cold, sum Today, some Wes t mer-heat, d ampness, ern herbal isrs depict phlegm , fire, or some ginseng as being binding of influences strongly srim ularing w ithin the body. An and overly hearing, a application of ginseng view that is quire con is always appropriate trary to the traditional when rhe evil influ one, even for the ences rhat caused a processed (red) Asian patient's illness have ginseng, described by lefr rhe body, bur the traditional doctors as proper influences are being only "warm" in still weak; o r when nature. In fact, much only a lirtle of rhe evil of the red ginseng influences remain, bur from China, such as the proper influences Jilin (Kirin) ginseng, are exhausted; or is described as having when evil influences a nature that is neu have penetrated tral, reflecri ng Its Codonopsis Codonopsis pilosula. Photo © 2002 stevenfostercom deeply into the body mildness. and proper influences Dr. Shiu-ying Hu translated 42 recipes with ginseng from are themselves roo weak to drive off the evi l influences. Li Shizhen's compendium." They are used for conditions In order to support the elimination of evil influences such as being thirsty all rhe rime; having poor digestion, by means of herbs, one must give rhe patient ginseng "s tomach trouble," nausea, or vomiting; feverish diseases together w ith other herbs that are capable of driving off with excessive swearing, cough, or laryngitis; bleeding disor the evil influences. However, before one appli es ginseng, ders, including internal hemorrhage, nose bleeding, blood in one should examine whether rhe disorder to be treated rhe urine, and post-partum bleeding; and pregnancy disor is minor o r serious [rake into accounr the balance ders. Typical daily doses are 8-15 grams of ginseng in decoc between the proper and evil influences], and o nly if this tion or 6 grams in powder form, made into pi ll s. is taken into account will the effect of rescue from dan Ginseng Misuse and Ginseng Substitutes ge r or of strengthening rhar which is already bent [dam Declining wild resources of ginseng aged] appear as a matter of course. If one fai ls to inves eventually led to considerable distor tigate, tho ugh, whether evil influences tions in concepts about the nature of hen ginseng failed to are present or nor, and whether the ginseng and how it could be used. Gin person suffers fro m depletion or reple accomplish its claimed seng sellers exaggerated the benefits of W tion, and if one adm inisters only warm rhe herb to justify the increasing price. revival and the person died, or hot substances of a purely supple During rhe Qing D ynasty (I 644-1911 ginseng was sometimes blamed menting nature [as is commo n practice C.E.), ginseng was known as the herb for the death. today due to current medical theories], rhar could res tore the dying to health then one will merely supplement the 2002 HerbalGram 54 39 evil influences and help them set version of Si }unzi Tang, described pre de down. In minor cases, the evil he primary response to viously. T his story relays quite well the influences wi ll, as a result of such T the rapidly diminishing frustration that some doctors felt in mistaken therapy, never leave the supplies of ginseng was for the growi ng myths about the dangers body again. In serious cases, death herb collectors to flood the of ginseng. is inevitable. market with substitute herbs. It was during this time period that In other words, if the pathogeni c ginse ng, being rare and increasingly influence has not been removed or imbued with intense properties, had tamed, one must combine ginseng with gained a reputation for being exces other herbs that have the effect of dispelling the evil, but not sively supplementing, and, by virtue of being linked with with other herbs that have a tonifying nature; otherwise, the other supplementing herbs that were class ified as warming, it disease can become permanent or even cause death. T he say gained a reputation by some as a warming herb. An herbal ing at that time translated as: "Improvi ng the body's condi published in 1757 C. £. '5 for the first time described ginseng tion with tonics when a pathoge n is present is like inviting a as warm in nature and included the comment that "the robber into a comfortable home; he would gladly enter and effects of ginseng are superior to all other drugs." An expla not leave, taking time to steal all its valuables. " As a result of nation of Cheng Maoxian's application of ginseng in the the new view of ginseng as a remedy to rescue those close to above case is provided by the description of ginseng in this death with a potential for harm if misprescribed, Zhang Lu , herbal: "It has a great abiliry to supplement the original qi in a physician of the Qing Dynasry, commented: "Some people the lung. It drains internal fire and eliminates heat that caus look upon gi nseng as poison or a sword [rwo-edged, able to es a fee ling of uneasiness in the ches t. It generates body flu provide help, but also to des troy], and stubbornly refuse to ids and quenches the thirst." 13 use it." Stori es about the rari ry of ginse ng during the 19th ce ntury An example of this mixed thinking about ginseng was were rel ayed by Western visitors, and several of their com relayed by phys ician Cheng Maoxian at the beginning of the mentaries are in Pamela Dixon's book, Ginseng. '6 T he Dao Qing Dynasry peri od. He described in detail the trea tment Guan Emperor (1821-1851 C.E.) recogni zed that ginseng of a very difficult case, a 63-year old wo man suffering from was on the verge of ex tinction and fo rbade its coll ection by a disease that came on suddenl y and led Imperial D ecree. A report in the to vi rtual inabili ry to swallow, everyone Peking Gazette of 1884 stated that 20 sure that she would soon die. Cheng ginseng roots were se nt to the Guan Xu ex plained his next therapeutic steps: " Emperor (the last C hinese Emperor to Her chest still was not free, so serve a full life in office). next I used Shen Ling Bai Zhu San The primary response to the rapidly [Ginseng and Atracrylodes Combi diminishing supplies of ginseng was for nation]. The lady knew that I was herb coll ectors to flood the market with using ginseng and feared that her substitute herbs. The main one selected ches t would not ease but be as a match for ginseng was codonopsis stopped up from excessive support ( Codonopsis pifosula, (Franch.) Nann f., ing action. For this reason, over sev Campanulaceae), an herb botani cal ly eral days I added one and one-half unrelated to ginseng which, nonethe qian [4.5 grams] of ginseng without less, was said to be about the same in letting her know. After these doses, effects, only safer, cheaper, and abun her ches t was opened and her stag dant. Although the root just barely nati on downward abated. O ne day, resembles the ginseng root, by this time the lady said to her son Shunian, in China's hi story vi rtually no one "In the last few days, my gullet has knew what ginse ng looked like, so mer felt open; don't use ginseng any chants could call it "ginseng. " T he Chi more." Shunian murmured his nese name for the herb, dangshen, indi assent but together with my unwor cated th at it was ginseng fro m the thy self, he secretly added ginseng Shandang region (shen is the key term without ill effects for seve ral days. Codonopsis Codonopsis tangshen. to describe ginse ng or a gi nseng-like ... Though the disorder was grave, Photo © 2002 stevenfoster.com herb); Shandang had been the principal she was res tored to life. Half the source for the preferred quali ry P. gin merit was Shunian's, for the rwo reasons that he was seng, a plant hunted to extincti on in that area. Codonopsis a filial and friendly gentleman. First, he did not spare had not appeared in any of the herbals prior to the Qing the ginseng; and second, he gave me complete Dynasry, but had received brief mention in the Bencao Gang charge. H ad he looked for overnight success, or mu. Some doctors of the Qing Dynasry regarded dangshen as feared to use ginseng and huangqi [as tragalus root the correct ginseng to use, bei ng superior to renshen (i. e., gin (Astragalus monghoficus Bunge, Fabaceae); another se ng) for most applications. '- Codonopsis became an official tonic herb with action similar to ginseng], or, taking substitute for ginseng, widely used as such today, but the Chi alarm, had changed doctors, the lady his mother could nese market has had numerous other substitutes as well. Table scarcely have preserved her life. I (page 43) lists herbs that are used as substitutes for ginseng, 18 9 Ginse ng and Atracrylodes Combination is an ex panded according to recent texts. ·' 40 HerbalGram 54 2002 Most of the ginseng toxic (e.g., th e planes substitutes are of rhe fami lies obtained from three Solanaceae and Phy plane families (Cam rolaccaceae), panulaceae, Apiaceae, though their and Asteraceae) that preparation In have a confirmed C hinese for close relationship mulas has nor with ginseng in terms been associat of flowering pl ant ed with any evolution.' 0 They may problems ev i contain similarly dent to C hinese structured active herbalists. It is poss i components and/or ble that so me of the present an appearance complaines about the that is reminiscene of dange rs of ginseng ginseng. A few of raised during the Qing them are potentially Balloon flower P/atycodon grondirorus. Photo © 2002 stevenfostercom D ynas ty arose from incidents where cer- rain ginseng substitutes were improperly used. The Five Shens: The broad range of substitution options for ginseng (see related article, at left) helps illustrate the fact that the actions Ginseng Substitutes in of P. ginseng were nor seen as unique to the one herb. Rather, rh e therapeutic effects could be attained, to some extent, Traditional Chinese Medicine from other plants. In a few cases, the active constituenes of he problem of unknowingly receiving substitute the substitute herbs are similar. For example, modern inves T herbs is alleviated today by reliance on cultivated tiga tions reveal that the saponin componenes of plarycodon, ginseng and cultivated codonopsis. Furthermore, several or balloon flower, (Platycodon grandiflorus (Jacq.) A. DC., herbs named shen, to indicate that they were used in Campanulaceae) have a structure ve ry similar to that of the place of or like ginseng, have become separate entries in ginsenosides. "·" By such analys is, it was found that a plane materia medica and are now intentionally distinguished. that had only been used as a fo lk remedy in China, jiaogu lan, also call ed gynosremma or blue ginseng ( Gynostemma • mingdangshen, known also as changium or bright pentaphyllum (Thunb.) Makino, Cucurbiraceae) , contains codonopsis ( Changium smyrnioides H . Wolff, Api some of the same saponins as those found in ginseng, and aceae); recently has been adopted as an inexpensive ginseng substi • taizishen, called pseudostellaria or prince ginseng tute. Unlike plarycodon, the root of which looks somewhat (Pseudostellaria heterophylla (Miq.) Pax, Caryophyl like ginseng and is the parr used, gynosremma tops are uti laceae} ; lized, and there is no chance of mistaking it for renshen; it is beishashen, known as glehnia, beach silvertop or simply used in the same manner. northern sand ginseng ( Glehnia littoralis F. Schmidt Today, virtually all Chinese medical texts and journal arti ex Miq., Apiaceae; see Adenophora in Table 1) . cles - reflecting actual practice in Chinese clinics - Even in ancient times, Tao Hongjing (456-536 C.E.), a describe herbal formulas with codonopsis where ginseng famous herbalist who revised and expanded the Shen would formerly have been indicated as the appropriate herb. nong Bencao ]ing, described five types of ginseng: Codonopsis is nor generally popular in the West since it has so little market value (it is easy to grow and has a low cost) • renshen, (man-shaped ginseng; P. ginsent); and it has so little of the colorful history of ginse ng. • danshen, commonly known as cinnabar-colored ginseng or Chinese salvia (Salvia miltiorrhiza Western View of Ginseng Bunge, Lamiaceae); Among the first Westerners to attempt to penetrate the veil • kushen, called bitter ginseng or Japanese sophora of C hinese herbal medicine were the British phys icians F. (Sophora japonica L., Fabaceae); Porter Smith and G.A. Stuart, working in C hina at the end of the 19th century and into the early 20th century, as the known also as black ginseng or scophu • xuanshen, Qing Dynasty was coming to an end. They wrote:'-' laria (Scrophularia ningpoensis Hems!., Scophulari aceae); and Ginseng, with the Chinese, is the medicine par excel lence, the dernier resort [last recourse] when all other • nanshashen, also called adenophora, ladybells or drugs fail; reserved for the use of the Emperor and his sand ginseng (Thunb. ex (Adenophora triphylla household, and conferred by Imperial favo r upon high Murray) A.DC., Campanulaceae). and useful officials whenever they have a serious break In 1596, Li Shizhen preseneed a modified version of down that does not yield to ordinary treatment, and this list with quan shen or bistorr, purple ginseng (Poly which threatens to put a period to their lives and use gonum bistorta L., Polygonaceae) replacing nanshashen in fulness .... The ordinary ginseng of the markets has been this system of five ginsengs. studied and has not been found to possess any impor- 2002 HerbalGram 54 41 gator had hi s own op11110n about the action of ginseng." Even later, this concern lingered. In a report at the 1978 G inse ng Symposium in Korea, Prof. E.]. Staba of the Uni vers ity of Minnesota Coll ege of Pharmacy said , "The phar macological effects reported for ginseng and its extracts are varied and controvers ial. "" While so me peopl e simply dis missed the ginseng claims as the result of myths and super sri rions, others decided to track down a bas is for the rever ence for ginse ng. Identification of Chemical Constituents As a first step in separating the myths about ginseng from what it co uld actuall y do from the modern scientific per spective, its active in gredients were sought. A history of these effo rts was reviewed by Joseph Hou in great detail in an arti cle2(' and with an overview in his book: Ginseng: The Myth and the Truth. '- Ginseng was found to contain none of the potent alkaloids Nature and Taste in Tienchi Ginseng Panax pseudoginseng var notoginseng. Traditional Chinese Medicine Photo © 2002 stevenfostercom A ccording to classical theory, the nature (Chinese: rant medicinal properties. Bur the C hinese describe .r\xing) of an herb can be likened to certain human cases in which the sick have been practicall y in articulo characteristics, which may be described under the head mortis, when upon the administration of ginse ng they ing of personality. It depicts not only what the herb is were sufficientl y restored to transact fin al items of busi like inherently, but also how it will interact with other ness .... It is prescribed in nearly eve ry kind of disease of herbs in a formula and with those who consume it. The a severe character, wi th few exceptions, but with many herb's nature is classified, in short, either as cold, cool, reservations as to the stage of the disease in which it may neutral, warm, or hot. This refers to the group of effects be administered with the greatest benefit and safety. the herb will have on the body, not the temperature of Much of the ginseng on the market consists of campan the herb. In general, warm or hot herbs can be used to ulaceous roots (i .e., codonopsis, adenophora, platy treat disease conditions that are characterized as being codon; fami ly Campanul aceae), substituted for those of cold and herbs that are cool or cold in nature can be used the arali aceous Panax. The former roots, while in a gen to treat disease conditions that are characterized as being eral way resembling those of the true ginseng, are more hot. Neutral herbs can be used for any disease condition, or less hard and woody, and free from worms, while the and, because of their mild nature, both warm and cool latter is succulent and very li able to attack by insects. 10 herbs can be used with considerable flexibility in treating The main use of ginseng, depicted here, was for those hot or cold type diseases. By contrast, the more extreme who were severely ill. The ginseng used by the Emperors natured herbs, classified as hot or cold, have to be used with some caution. and their households was the wild ginseng; the market gin seng consisted mainly of cultivated roots (as used today) The taste ( wez) of an herb represents how the herb was and substitute roots of codonopsis. All the market sa mples formed from the basic elements of the universe, what were declared to be virtuall y worthless from a medicinal properties it will have, and what organs it will affect. point of view, an opini on held by so me researchers and T here are five basic tastes: sweet, acrid (also called pun physicians today with regard to gi nseng and irs products. gent or spicy), bitter, sour, and salty; also, an herb can be We will never know if wi ld ginseng had remarkable prop described as bland (rather tas teless), which represents an erties not found in the cultivated roots: there is not enough added sixth ca tegory. T he ancient Chinese concept of the left to rest clinically. internal anatomy involved five fundamental viscera: T he statement above by Smith and Stuart- about spleen, lung, heart, liver, and kidney-each one associat fa iling to find any important medicinal qualities in ed with, and particularly influenced by, one of the five ginseng- refers to the initial investigations by the tastes. The connections that were made in ancient times scientific method of this highly acclai med herb. between the tastes and organs can be explained by simple Ginseng seemed to hold great promise, based on observations; for example, the kidney yields the salty tast the extravagant Chinese claims, yet little turned up ing urine and is therefore associated with the salty taste. when it was studied. Often, the effects reported by As an example of the relationship between taste and one researcher contradicted those of the next, and a effects, sweet herbs are said to enhance the function of the variety of explanations were devised to explain the "spleen" (which refers not to the anatomical spleen bur to results. As described in the book Korean Ginseng,' 4 reviewing an organ system that mainly comprises the digestive func the history of ea rly ginseng research efforts: "Every investi- tions), to calm irritations, and to nourish the body. 42 HerbaiGram 54 2002 characteristic of many plants that were being relied upon ro then subsets of each labeled 1, 2, 3. As of 1999, it was repon generate new drugs. Instead, the root is comprised mainly of ed that 34 ginsenosides have been identified in Asian ginseng carbohydrates: starches, cellulose, and free sugars (the roots;!"' the dominant saponins in P. ginseng roots are of the sucrose content in fresh ginseng is about 25 percent and the Rb se ri es and are of the dammarane ty pe. Most of the rota! sugar and starch content is over 60 percent), the sort of other saponins are prese nt in miniscul e amounts (the things fo und in a carrot roor.'' In fact, like carrots, ginseng nex t larges t group, the Rg series, also of the can be used fresh as a health food or vegetable. '- Panaxynol, dammarane group, are presem at about one-third one of the acetylenic compounds fo und in ginse ng, is iden the quanrity of the Rb series in P. ginseng) .'" tical ro carotaroxin isolated from carrots.!' A small amount of T he ginsenosides are found ro be concemrared a saponin (s ugar bound ro a rriterpene molecule) was discov primari ly in the root's conical tissues (outer layers), ered in the ginseng roots, and this component was shown ro with lower quantities in the interior portions. Accord have some pharmacological activiry. Saponins and their re lat ing ro one C hinese report, rhe ginse nos ide conrenr of the ed rriterpenes (e.g., oleanolic acid , a common componem of root hairs (fibrous lateral roots which are mainly corti cal type plant oils) are found in numerous herbs and also in some materi al) was 9. 7 percent, while rhat in rhe thicker lateral food plants (e.g., soybeans, alfalfa sprouts, olives, and pump roots was 6.4 percent, and that in the main rap roor (wh ich kins). is the portion usuall y traded on the market, having little cor For several decades, efforts have been made ro carefully iso tical material) was only 3.3 percent.!' An earlier European late and identify each of the ginseng saponins, which are the re port gave the fig ures as 5-7 percent, 2-4 percent, and mai n bitter components of ginseng. T hese saponins, fo rmer 0. 7-1. 7 percenr for rhese ginseng root parts, respectively:" ly called panaxosides, are now call ed ginsenosides, of which European evaluations of ginse nosid es in ginseng sam ples there are several variants, labeled Ra, Rb, R,; and so on, and frequently generate lower figures for ginsenoside levels rhan Table I Herbs Used as Substitutes for Ginseng in Traditional Chinese Medicine Binomiai,Authority Family Comments Vigna vexil/ata (L.) A. Rich. Fabaceae (Leguminosae) Steamed or boiled root of this type of cowpea is similar to red ginseng. Talinum panicu/atum Uacq.) Gaertn. Portulacaceae Turenshen (local ginseng). Peeled and soaked in boiling water, it appears similar to red ginseng. Physochlaina infundibu/aris Kuang Solanaceae Huashanshen (flower mountain ginseng) or reshen (warm ginseng). Henbane (Hyoscyamus nige r L. ), of the same plant family, is also used as warm ginseng. Pterocypsela indica (L.) C. Shih Asteraceae (C ompositae) Taste of the root of t hi s type of lettuce is (syn. Lactuca indica L. ) somewhat like ginseng. Phyto/acca acinosa Roxb. Phytolaccaceae Shang/u.American poke root is a close relative to this, which is also known as Chinese poke, or sweet bellado nna. Mirabilis jalapa L. Nyctaginaceae Zimo/i. Native to American tropics, where it is called four o 'clock. Platycodon grandifforum Uacq.) A. DC. Campanulaceae Jiegeng. The active constituents of platycodon are similar to those found in ginseng (saponin glycosides). O ther common names are balloon flower, Chinese bellflower and Japanese bellflower. Campanumoea javanica is from the same family and used similarly. Adenophora triphylla Campanulaceae Nanshashen . Also known as southern sand (Thunb. ex Murray) A. DC. ginseng, or ladybell s, several other species of Adenophora are also used as ginseng substitutes. Rumex madaio Nakino Polygonaceae Red root appears somewhat like red ginseng (Rumex hymenosepalus Torr.), or canaigre, and was fo rmerly sold improperly as "American red ginseng." Sources: Zhu YP. Chinese Materia Medica: Ch emistry, Pharmacology, and Applications. Amsterdam: Harwood Academic Publi shers; 1998. Liberti LE, Der Marderosian A. Evaluation of commercial ginseng products. } Pharm Sci 1978; I 0:1487-9. 2002 Herba!Gram 54 43 Asian studies. According to C hinese studies, the range of val steamed to produce red ginseng also arise during preparation ues for total ginsenosides for P ginseng roots (taproots) is 2.2 of ginse ng tea and ginseng extracts. 36 Another factor inAu percent-5.5 percent, with 4 percent being a typical amount encing the difference in ginse noside com em between white mentioned in the literature.2232 Euro pean literature mentions and red ginse ng is the removal or retention of the outer root 1. 5 percent and 2.0 percent gi nsenosides as a minimum level skin. White gi nse ng is freq uently prepared by peeling the to be expected for the roots (Swiss and French Pharma root. Since rh e ginsenos ide comenr is particularly rich in the copeias, respecti vely), with some studies revealing a range of peel, this process ing results in a relatively low gi nsenoside 3 levels from 0.7-3.0 percent. .J It is unclear whether the diver coment. Red ginse ng, on the other hand, is processed by gence in reponed levels of ginsenosides between Asian in ves steaming the unpeeled roots. ti gators and European in ves tigators is due to different selec Although ginsenosides have been rhe fo cus of research on tion of root material for resting, different handling of the ginse ng acti ve constituems, other compounds in the root roots prior to resting, or different resting methodology and have been discovered to have biological activity. T hese interpretation. A discuss ion of this significant variabili ty in include acetylenic co mpounds, peptide glycans, polysaccha- reponing does nor appear in the published reviews of gin rides, pyran deriva seng. tives, and fl avones. 21 Higher levels of gin One can demonstrate se nosides than these pharmaco lo gica l found in P ginseng activity of these sub (with a differing mix stances when they are of individual sub isolated and conce n types) are reponed for trated; for example, American ginseng (P the acetylenic quinquefo!ius L.), at panaxyno l, panaxy 6.2-7.4 percem, and dol, and panaxytriol for T ienchi ginse ng show cytotoxic activi (a .k.a. san q1) of ty in vitro. Such so uthern C hina (P action is potemiall y of pseudoginseng Wall. value in cancer treat var. notoginseng menrs, but only if the (Burkill) G. Hoo & cytotoxicity is highl y C. ] . Tseng), at 3- 8 specific fo r cancer percem ginsenosides, cells. Similarly, the with some reponed Asian Ginseng Panax ginseng. fresh from the earth. Photo ©200 I Subhuti Dharamananda polysaccharides of levels of 12 percem. In ginseng, like those of a study of ginse no- the medicinal mush- sides in ginseng roots fo und on the Taiwanese market,34 it rooms, can enhance certain immune functions, as demon was reponed that the highest coment was found in P pseudo strated in laboratory animal invesri gations. 37 T he dose of ginseng var. notoginseng, fo llowed, in order, by P quinque these immunologically active polysaccharides when isolated folius, P ginseng root hair, and then red and white P ginseng and used clinically are about 1-3 grams.38 The amounts of roots (tap roots, as commonly sold in stores). In that evalua these non-saponin substances that are present in ginseng tion, only relative total ginsenoside levels were reported, nor roots are very small: they are unlikely to significantly con the specific amoums in each root. tribute to the purported clinical effects of ginseng when the Studies of ginse ng processing, in which the roots are roots or their standard extracts are consumed in ordinarily steamed soon after coll ection, indicate that red ginseng recommended quam iries. Similarl y, gi nseng comains B vita (often referred to in the literature by its pharmacopeia! name mins (BI and 82) and trace elements (mainly manganese), Radix G inse ng Rubra, which des ignates the plam parr of which have a therapeutic action in large doses, but the radix (meaning root), and, in this case, its processi ng or amounts co nsumed when taki ng modern ginseng products color, rubra (meaning red), usually has a higher ginse noside are trivial compared to dietary sources. com em than white ginse ng. During the process to make red Pharmacology Experiments ginse ng, malonyl-ginsenosides are converted to their corre- Pharmacology ex periments are conducted with test systems sponding gi nse nosides by hydrolys is. According to a that help determine the actions a substance might have on 1 report on Ameri can ginseng, .l the steaming process cultured or harves ted cell s (i.e., in vitro) or on a li ving animal used to produce red American ginse ng increases the (i.e., in vivo). With proper des ign, the tes ts can help elucidate level of irs ginse nosi de Rb 1 by as much as 100 per the physiological mechanism by which the herb produces the cem by conversion of malonyi-Rb 1 to Rb I· T he observed effects. Tests can be conducted on whole herb acidic malonyl compounds are poorly absorbed in materials (e.g. , by adding the powder to the diet), herb humans, bur imestinal bacteria metabolize malonyl extracts, and isolated acti ve fractions (i.e., groups of chemi ginse nosides to neutral ginsenosides, which are better cals) , or individual chemicals from the herb. absorbed. A small amount of acetyl-ginsenosides are also generated from the malonyl-ginsenosides when Several of the initial pharmacology studies of ginseng were preparing red ginse ng.' 8 It has been proposed that some of based on a well-known story in C hina about the way to the changes in ginsenosides that occur when white ginseng is determine whether a ginseng root was genuine. "In order to tes t for the true ginse ng, two persons would walk together, 44 HerbalGram 54 2002 one with a piece of ginse ng root in purposes). It is quite difficult to convert his mouth and the other with his t this time, there is no dosages in laboratory animals to those mouth empty. If at the end of 3-5 li A evidence to support the that would be used in humans, but with [3 li is about one mile], the one with contention that the mix of proper study design and analys is of ginseng in his mouth does nor fee l ginsenosides, at the dosage factors influencing pharmacoki himself tired, whil e the other is out netics, it is possible to estimate of breath, the ginseng is genuine." ingested, has any sign ifican t what might happen in humans. The earl y pharmacology experi influence on the effect of ginseng. A detailed analys is of conversion ments (during the 1960s) involved factors for such laboratory stud- giving ginseng to res t animals (mi ce ies to human clinical applicati ons and rats) that were then forced to keep moving until they was carried our by John Boik." He indicates rh ar the became so fatigued that they had to stop (usually a forced 25-250 mg/kg dosage range in mice corresponds to swimming res t or forced climbing test). T he ones given gin about 1-9 grams of ginseng for human use and rh ar labora seng were reported to be able to carry on longer. " tory studies of ginseng for inhibiting cancer growth utilize The effect of ginseng on overcoming fatigue due to over amounts co rresponding to a human dosage of 3.2-47 grams working was viewed as an "antistress" ac ti on, and other stud per day. The amounts of herb material used in the pharma ies fo cused on ginseng's ability to protect animals from vari cology tes ting for ginse ng are similar ro the amounts used in ous other types of stress, such as heat and cold , low oxygen, pharmacology tests of other C hinese herbs that are adminis exposure to ionizing radiation, and infections. These efforts tered to humans in doses of 3-9 grams per day. " were the source of the concept of gi nseng, and other herbs, In addition to pharmacology studies that indicate reduc as adaptogens: substances with a relatively hi gh degree of tion in factors associated with risk of heart disease, some safety that helped the organism adapt to various types of inves ti gations have indicated that gi nse ng administrati on in stress. animals improves immune functions, reduces stress-induced Ginseng research was influenced also by the growin g con ulceration, provi des antioxidant effects, inhibits induced 19 ce rn about cardiovascul ar diseases rhar had become rhe lead tumor formati on, and improves oxygen utilization. T hese ing cause of death in developed nations. Since ir was said in diverse beneficial effects of ginseng we re noted ro be similar 40 the ancient texts rhar raking ginse ng regul arl y could prolong to those being reported at the same time for vitamin £. li fe, ir see med reasonable to demonstrate that ginse ng could Despite the extensive research efforts, ginseng was not reduce the ri sk of death from ca rdiovascul ar disease. To give accepted by the modern medical profess ion outs ide of Asia as credence to this outcome would require mass ive clinical tri a remedy for these health iss ues. It is not surprising, then, als with people taking either ginseng or a placebo over a peri that the Western ginseng market shifted focus ro a different od of many years, but, to start rh e inves ti gative process, one area of co ncern: energy. could administer ginseng to animals in Ginseng and Energy: A New the laboratory and observe its effect on Twist known ri sk factors. T he Chinese term qi, which has a rich Ginse ng researchers in China, Korea, meaning in the Chinese culture, was and Japan carried our numerous labo translated by some Westerners simply as ratory animal experiments showin g "energy." The concept of tonifying qi in that ginse ng could lower blood choles the C hinese medical sys tem was depict terol and lipids as well as blood suga r ed as stimulating energy. In other - rh e key elements in the blood that words, when a person was fee ling run were the primary focus to determine down, instead of, or in addition to, tak the risk of developing cardiovascular ing a cup of coffee, one could take gin disease. T hose studies led to a co ntinu se ng, a qi-tonifying herb in order to feel ing inves ti ga ti on in several countries some immediate energy. In her book and to human clinical trials. Asian Health Secrets," Letha H adady In order to determine the poten ti al of described the situation this way: "Most a pharmacology study to predict a cor Westerners use C hinese ginse ng like jet responding clinical outcome, one must fuel, to drive themselves beyond their translate the laboratory dosage to the capacity." clinical dosage. The pharmacology T he claim that ginse ng increases ener ex periments with gi nseng that helped gy has become the lead conce pt in gin animals' survival under stress and that seng marketing. Today's fu nctional reduced risk factors associated with car foods include ginseng in the category of diovascul ar disease appear to support "energy products," and ginseng is found the dosage of ginse ng recommended in Blue ginseng or jiaogulan Gymnostemmo penw phyffum. Photo © 2002 stevenfoster.com in many of the herbal capsul es, tablets, the C hinese literature. Most of the or liquid preparations aimed at improv studies on laboratory animals conduct- ing energy. Ephedra, or ma- huang (Ephedra sinica Stapf., ed in C hina, Korea, and Japan were based on doses of gin Ep hedraceae), with its potent alkaloids, has been promoted se ng in the range of 25 mg/kg of body weight to 250 in the sa me way for this purpose (typica ll y at 20-25 mg mg/kg,"-39 though hi gher doses, such as 400 mg/kg, have ephedrine alkaloids per dose, up to three or more times per occasionally been used in tes ts (e.g., for immune stimulation day). In an effort to get an energy boost from herbs, people 2002 HerbalGram 54 45 have so metimes used extreme difference in the herbs. T here is no sub amounts or unusual combinations of n an effort to get an energy stanri ve evidence that any difference in herbs. One res ult can be adve rse reac I boost from herbs, people ginse noside proportions between Asian ti ons and the resulting negative pub have sometimes used and American roots produces any dif li city and fear. ference in clinical effect. First, C hinese extreme amounts or unusual Fo r example, a "ginse ng abuse syn ginse ng comes from the far north of drome" was described in an uncon combinations of herbs. C hina; American ginseng was always trolled and highl y conrroversial study One result can be adverse impo rted through Canton, in the far reported in 1979."' Although the reactions and the resulting so uth. From this ex peri ence, the C hi nese had viewed their own ginseng as a validity of this sy ndrome was later negative publicity and fear. chall enged,'3 it remains a caution that northern product and the American is often raised about ginse ng, rega rd- ginse ng as a southern product. In fac t, less of the amounr ro be consumed. Ameri can ginse ng is obtained mainl y For the most part, the adve rse reactions attributed to exces from the northern part of the eastern U.S. and Canada, sive use of ginse ng, as reported in the 1979 article, may have regions that are geographica lly similar to the part of C hina been due to other products also used in excess at the same from which Asian ginse ng is obtained. Although the range of rime (i ncluding high levels of caffeine). Some people, how American ginseng reaches so uth, to northern Georgia and ever, have consumed unusuall y large amounts of ginse ng to across to northern Arkansas, the ginse ng shipped to C hina in get an immediate reacti on and this may have generated the old days and now is from the northern U.S. Tienchi gin adve rse effects, es peciall y with prolonged overdosing. se ng, or san qi whi ch comes from Southwest C hina, also grows as far south as Georgia and Arkansas; it is sa id to have The late Israel I. Brekhman, the Russ ian proponent of a warm nature, but was nor part of the iss ue that had arisen using herbs such as ginseng as adaptogens, described gin se ng wi th imported American ginse ng. as hav ing a stimulant action and Russian researchers focused in on th is potential T he north, being cold , would yield , by appli cation.'- By contrast, C hinese ancient dogma, a product that benefits researchers insisted that ginse ng func yang, the south, being warm, would yield tioned as a sedative and calming agenr; a ve rsion of the same herb that benefi rs the ability to overcome fa ti gue, for exa m yin. Although, to this day, American gin ple, was described as the res ult of having se ng is classified among the yin nourish less stress on the body rather than having ing herbs in some Chinese herb guides, it more stimulation. One peculiar effort to is not described as more calming than resolve the differences in these viewpoints the Chinese species, which is already was made by a japanese researcher, depicted as having a calming action; it is Hiroshi Saito, who suggested that gin so metimes said to be more cooling, how se ng did both: some of the ginse nosides, ever, and useful in tea for the sweltering particularly the Rg series, were sti mulat summer heat of southern China. ing in nature while others, particularly To quote from one C hinese herb guide the Rb series, were calming in nature: ' derailing the uses and applications of 3 H e and co-author Yien-mei Lee pointed Ameri ca n ginse ng: ' "Traditional uses: out, "We noticed that multiple pharma nourishes yin, cleanses heat, increases codynamic activities of ginse ng ori ginat salivation, supplements the lungs, mois ed from various ingredients and there are tens, and depresses fire. Applications: many pharmacologicall y antagonistic heat sym ptom-complex, pulmonary actions in ginse ng. " H ow these apparent tuberculosis, dry cough due to defi cien ly co mpeting effects of some acti ve com cy hear. " Ignoring the historical origins ponents could explain the difference of of the different concepts about American Eleuthero Eleutherococcus senvcosus. opinion about ginse ng effects when gin - Photo© 2002 stevenfostercom and As ian ginseng, those who discuss the se ng was used as a whole preparation and energizi ng or calming effects suggest that not subdivided was never made clear by the difference involves the precise mix or any subsequent authors who relayed this concept. ratio of ginsenosides. At this time, there is no evidence to As an exa mple of the confusion generated by those support the conremion that the mix of ginsenosides, at the making claims for ginseng's effect on energy, it has dosage ingested, has any significant influence on the effect of been suggested that Asian ginse ng is "stimulating, " ginseng. There have been no valid measures for sti mulant but that American ginseng is "calming." The o ri gin properties of ginse ng as applied to humans and there have of this concept may be traced to the Chinese view bee n no comparative studies of the clinical effects of the di f regarding yin and yang. In C hina, it has been said ferent species of herbs sold as ginse ng. One cannot say with that C hinese ginseng has the ability to tonify qi and scientific ce rtain ty whether one species is better, worse, o r invigorate yang [co rresponding roughly to metabo different in effect than the others. lism and movement], while American ginseng has the Challenges Arising with Ginseng Products abili ty to tonify qi and nourish yin [corresponding roughly and Their Use ro control and calming] . However, this analysis comes about from a peculi ar historical situation rather than an inherent Disturbing reporrs began to surface in the late 1970s and 46 Herba!Gram 54 2002 have been repeated several rim es sin ce, that so me ginse ng Such confidence is sometimes mi splaced. T hus, for exam products did nor co main ginse ng or comained only weak or ple, in the book H erbal Prescriptions for Better Hea!th,"1 the inacti ve ginseng, as had bee n suspected by ginse ng ex pens author, a naturopathic physician, states that: "The best for many years. Tests were developed w evaluate commercial researched form of ginseng is ex tracts supplying products for ginse noside comem, which was found w vary approxim ately 4 to 7 percent ginsenos ides. The rec considerabl y. "' In the first such study, conducted by ommended dosage is 100 milligrams once or twice researchers at the Philadelphia Coll ege of Pharmacy and Sci da il y. Crude non-standardized exrracrs require a ence, so me of the commercial products analyzed comained higher dail y dose of 1 to 2 grams." In fact, the stan so-call ed "Siberian ginseng," an herb that was being promot dardized ginse ng ex tracts mentioned here are rhe ed initially by the Soviet Union (and later by C hina; where most frequently resea rched of rhe commercial extracts, the term eleurhero ginseng, wujiashen, was more su itable). Ir bur not necessaril y the best researched, and there is no was deri ved from eleuthero (Eieutherococcus senticosus (Rupr. evidence that other non-standardized extracts (o r, as more & Max im) Max im., Arali aceae) , which comains no ginseno commonl y used in cl inical rrials, gi nseng powders) need ro sid es. T he term "Siberian ginse ng" has been repl aced with be used in doses rhar are I 0 times higher. T he aurhor's impli "eleuthero" w make clear that this plam is not in the ge nus carion is rh ar by standardizing the exrract, it becomes fa r Panax, and, therefore, not a rrue ginseng (in the Western more potent than other exrracrs, which is unproven and view that "ginseng" means a species of Panax). In a Swiss unlikely. 6 study reported at a C hinese medici ne conference in 1984," Unfortunately, by gaining co nfidence in material adminis six Asian ginse ng products were evaluated and found w con tered in trials by virrue of being standardized, readers may rain from as little as 0.3 mg ginse nosid es per dosage unit ignore other porential weaknesses or flaws in rh e design and (capsule) to 27 mg of ginse nosid e per dosage unit (a mpoule reporting of the srudies. In a review of ginseng's potential for of gi nse ng extract), a 90-fold range. affecting spans performance," much of which relied on using Finn Sandberg, a Swedish ginse ng resea rcher, described the rhe standardized ginseng preparations, rhe authors comment situation with regard to product va ri ability this way in rhar: "The published literature was characteri zed by numerous response w questions about the va lidity of ginse ng clinical statistical and design problems. Much of rhis research fai led ro rest res ults: '- "Does [the favorable clinical rest result] apply to control for va ri ous behavioral artifacts ... . "They found rhar other ginseng preparations? From a stri ctl y scientific point of "there is an abse nce of compell ing resea rch evidence regarding view, it is valid onl y for that particul ar batch of capsul es that the efficacy of ginseng use for rh e purpose of improving phys was used; bur it wi ll certainly be valid for other batches of ical performance in humans." Similarly, in a review and meta capsul es, provided they have an id emical composition. Here analys is, British researchers concluded," ... rh ere is co mpelling comes the problem! " Such concerns about the va ri abili ty of evidence for none of rh e claimed indications."'' ginse ng used for both resting and for commercial products O ne of rhe design fl aws rhar was nor mentioned in the led w promotion of what has been call ed "s tandardized gin rev iews of gin se ng trials was the low dosage of ginseng se ng." Standardized ginse ng has diffe rent mea nings for dif administered compared to rhar reported in Asian studies of ferem manufacturers, some have used the term loosely, such ginse ng. Since rh e Asian studies also suffer from several as when simple steps have been taken w ass ure that the prod se ri o us des ign flaws, any conclusions about gi nseng bene uct mee rs a certain level in terms of amount of ginse ng in the firs derived from those srudies are suspect. Sri II , if European product or the amount of total ginsenosides in the product. gi nse ng research repeatedly underdoses the ginseng, rhen The first product referred to as a "standardized ginseng" was call ed Gll5.'-·" The manufacturer of G ll 5 (Pharma wn, Lugano, Switze rl and, now a division of Boehringer Inge lheim) has nor described irs processing method, but has Parsing our TCMs claimed w provide I 00 mg of the ginse ng ex tract in a cap "\VJhen referring to Chinese medicine, there are two sul e, with 4 percem total ginse nosides. As described in a W variants in how it is written that have an under review article on ginse ng:" "Each capsul e of G 115 comains lying meaning. When written traditional Chinese med I 00 mg of a conce ntrated aqueous ex tract of P. ginseng C.A. icine, the intention is to describe the system of medicine Meyer, which is tirrared at 4 percent ginse nosid es and equiv that has been evolving since ancient times; the tradi alem to 500 mg P ginseng root." tional medical system of China. When written Tradi T he meaning of standardization developed by this compa tional Chinese Medicine, and abbreviated as TCM, the ny (which also produces a capsul e titrated w 7 perce nt gin intention is to describe the medical system that followed se nosides) appears to be two-fold: that both the amount of the establishment of the People's Republic in 1949. ginse ng extract in a capsule and irs percentage of wral gin While TCM is partly based on the ancient tradition, it se nosides are set at a certain leve l. However, no consistent has bee n modified to fit the political, social, and cultur defin ition of standards for such products has been utilized by al changes that were brought about by the revolution. the herb industry, although the American Herbal Products Some Western observers disparage TCM as a corruption Association has recently developed definitions recommended of traditional C hinese medicine; in C hina, TCM is to the industry.''' One effect of standardization is that it often viewed as saving rradirional C hinese medicine became a requisite of many Western studies to utilize stan from certain weaknesses and rescui ng it from dissolution dardized ginse ng. A certai n co nfidence in the value of the under the dominant influence of Western medicine studies using standardized ginse ng has evolved because the whi ch had been wid ely adopted by the end of rh e 19th ginse ng was well-defin ed, rather than simply giving a certain ce ntury. amount of root materi al without in formation about its gin se nos ide content. 2002 HerbalGram 54 47 no other design characteristic will overcome this funda bo). Only moderate effects were observed after three weeks mental Aaw. of daily administration of the ginseng capsules, with slight Shrinking Dosage Recommendations and favorable improvements in the risk factor measurements. European Research Two recent Chinese clinical trials made use of closely-relat ed ginseng formulations - Asian ginseng plus Tienchi gin While in China the recommended dosage of ginseng for seng with amber,'" and Asian ginseng plus Tienchi ginseng medicinal purposes has been consistent from ancient times and rhubarb root (species of Rheum, not specified in the arti up to the present (at several grams per day), the amount of cle) 17 - for treatment of angina pectoris and coronary heart ginseng suggested to be taken in the West has become rela disease, respectively. In the first study, the herbs were pow tively miniscule in some cases. Recommended doses of stan dered and administered at the dose of 3 grams three rimes dardized ginseng products are typically one capsule each daily. The total amount of ginseng (P ginseng plus P noto time. For the most frequently cited 4 percent ginsenoside ginseng) ingested by the patients each day was 7.2 grams. The extract in capsule form, the daily dose of ginseng extract pro treatment rime was 12 weeks. The study report indicated vided is just 200 mg and the daily amount of ginsenosides is that there were beneficial effects of the treatment and no just 8 mg. 53 This 8 mg of ginsenosides is said to be derived adverse responses were noted. In the from 1 gram of ginseng, which is the second study, the P ginseng was a lowest daily ginseng dosage recom water-based extract, while the P noto mended in any Chinese texts. hile in China the recom mended dosage of ginsengwas used as a powder. The daily By contrast, clinical work in Asia is W dose of the preparation administered carried out with far higher amounts of ginseng fo r medicinal purposes was 2.4. grams, with 1.9 grams of it ginseng and for uses that differ has been consistent from being a combination of the extract and markedly from those described in the ancient times up to the powder of ginseng. Although the con West. The Pharmacopoeia ofthe People's present (at several grams per centration of the extract was not stated, Republic of Chind officially lists 3-9 it is common to produce ginseng grams as the dosage for ginseng in day), the amount of ginseng extracts that are about 4:1, meaning decoction (tea) form. Thus, for exam suggested to be taken in the that the total dosage of ginseng crude ple, in the attempt to prevent and treat West has become relatively materials used to make a daily dose in cardiovascular diseases, ginseng is miniscule in some cases. the treatment regimen would be about given in this dosage range to lower 5 grams. Again, benefits were claimed blood pressure; by contrast, Western without report of adverse events during literature cautions persons with hypertension to avoid gin a treatment rime of 3 weeks. seng, especially to avoid red ginseng, even in the much lower Even in the treatment of infants, high doses of ginseng are doses used in the West. In a recent report from Korea, 14 red recommended in Asia. Gu Chifan, a 20th century pediatric ginseng was administered at a dose of 4.5 grams per day specialist, described the use of ginseng for newborn babies: (Korean red ginseng powder, 1.5 grams per dose, three times "The usual dosage is 3 grams a day. For infants of low birth daily) and reported to have a slight blood pressure lowering weight or neonates within 1-2 days after delivery, reduce to effect (about 5 percent) after two months daily administra 2 grams a day, as a drink or nasal feeding the steamed juice tion. In reviewing prior studies of ginseng's effect on hyper of red ginseng. Giving higher dosage is not necessary. Side tension, the authors of that study noted that there had been effects such as tachycardia will appear if the dose is over 6 negligible or minor effects on blood grams a day. Some individuals manifest pressure previously mentioned for slight diarrhea or rash after administra administration of 3 grams red ginseng tion for 3 days, bur it will disappear powder every day for three months and spontaneously after discontinuance. "18 with 3-6 grams of red ginseng powder every day for an average duration of 10 While an increasing number of Euro months. pean reports of ginseng effects based on small amounts of standardized ginseng As a reflection of this direction in gin appear in the literature, other seng research, the Institute for Tradi researchers are using quantities compa tional Medicine, of Portland, Oregon, rable to those used in Asia. For exam conducted a clinical trial in 1980 in ple, a Canadian study investigating the Santa Cruz, California, on Asian gin- reported blood sugar lowering effects of .-"""'1-~ seng on the risk factors for cardio- ginseng involved administration of 3 vascular disease: cholesterol, grams of American ginseng. 59 The triglycerides, elevated blood authors commented, "In our study, we sugar, and blood pressure." In noticed our effect with a high dose (3 that study, the first clinical grams) relative to that given by others trial of ginseng in the U.S., studying various types of ginseng in 100 patients received Asian red humans. A review of clinical studies ginseng (P ginseniJ provided by shows that quantity administered is the Korean Ginseng Research Insti- typically 1.5 grams or less." tute at a dosage of either 3.0 or 4.5 In all the cited reports from Asia, the grams per day (others received a place- Tienchi Ginseng Ponox pseudoginseng var notogmseng. Photo © 2002 stevenfostercom ginsenoside content of the ginseng is 48 HerbalGram 54 2002 nor specified. Studies conducted in rhe saponms isolated from P ginseng Asia reveal typical levels of ginseno lthough ginsenosides are fruits were administered to 327 sides of about 4 percent, while West A not the only active patients aged 50-70 to rest the ern studies indicate lower amounts. constituents in ginseng, they saponins' antisenility actions. The However, whether one uses rhe figure appear to provide the largest dosage administered was 150 of 1.5 percent ginsenosides as specified mg/day. A similar study was for an official minimum level for gin part of ginseng's co nducted with saponins iso seng that is to be used in Europe, or pharmacological potential. lated from P ginseng rhizome: uses the higher level reported in Asian 358 patients aged 50-85 were sources, the doses cited here corre- given 150 mg/day of the spond to from 45-135 mg (at 1.5 percent) to 120-360 mg saponins (50 mg each time, three times a day) for rwo (at 4 percent) of the saponin components. This is in marked months."' Prolonged administration of rhe saponins for contrast to frequent European and American indications for up to rwo years showed no adverse side effects. In a Korean use of standardized ginseng at doses of just 8-14 mg/day of study,63 ginsenosides of the triol series (e.g., ginsenosides of ginse nosides. the G series, as in Rg1 etc.) were given to 120 patients who According to information from the American Botanical had gone through gynecological laparotomies, in an attempt Council's recent study on ginsenoside content of commercial to aid recovery. The dosage administered was 230 mg/day. gi nseng products that carried some claims of standardiza T hese doses of isolated saponins are consistent with the tion,60 three brands that label their contents as Korean (now amounts expected to be obtained from rhe herbs when call ed Asian) ginseng root powder in capsul es (15 lots) were administered in rhe studies cited above with ginseng powders found to have an average ginsenoside content of 2.3 percent. and extracts, and are more than I 0 times higher than the Due to variability from lot to lot for each product, as well as saponin levels administered with the commonly used stan different amounts of powder packaged in each brand's cap dardized ginseng capsules. sules, the amount of ginsenosides per capsul e ranged from Getting the Right Dose of Ginseng 6.5 mg to 19 mg. While a consumer could be assured of When using P ginseng, rhe consumer would generally pre ingesting at least 3 grams of ginseng powder per day by tak fer to use the smallest effective dose possible, so as to have a ing just 6 of the capsules from any of the tested brands, the more convenient dosage form (fewer capsules or tablets), ginsenoside amounts that might be desired are not so readi lower cost, and smaller chance of side effects (assuming that ly assured. To get at least 100 mg of ginsenosides, one would high dosage may produce an adverse response in sensitive have to take 6 capsules individuals). Accord of the product with ing to the traditional rhe highest average and modern Chinese ginsenoside levels, bur literature, a 1-3 gram 11 capsul es of the dose of Asian ginseng product with the low root is consistent with est average ginseno a low dosage that is side levels of the rhree potentially effective. brands tested. Prod For those who may ucts comprised of gin require a somewhat seng extracts rhar were higher dose, this said to be standard amount could be dou ized usually provided bled or even tripled, less ginsenosides per for a short-term capsule rhan rhe prod administration peri ucts made from gin od, remaining consis seng powder. Further, tent with Oriental among different prod recommendations and ucts there was a wide Asian Ginseng Panax ginseng. Photo © 2002 stevenfoster.com clinical applications range of average gin for which little or no senoside content: side-effects are reported. Although ginsenosides are not rhe from 2.9 mg to 10.5 mg per capsul e (one product rhar mixed only active constituents in gi nseng, rhey appear to provide powder and extract had higher ginsenoside levels for some rhe largest part of ginseng's pharmacological potential. batches). To obtain ar least 100 mg of ginsenosides from the Therefore, some product manufacturers have provided con nine tested ginseng extract products that had some standard sumer information about ginsenoside levels. According to ization, one would typically have to consume at least 12 cap rhe analysis presented here, the ginsenoside amounts rhar sules, and possibly double that amount. Thus, the consumer would correspond to Asian use of ginseng and to rhe phar should be aware that ginseng extract products do not neces macology experiments are far higher rhan the amounts men sarily supply more ginsenosides rhan simple ginseng powder tioned in much of rhe Western literature. This literature has products, and that standardized extracts do not necessarily been strongly influenced by the European testing of certain provide a high level of ginsenosides. standardized ginseng extracts that provide relatively low lev T here are only a few studies conducted in Asia in which els of ginsenosides. 6 isolated ginsenosides are given clinically. In a Chinese study, ' It is not difficult to ingest rhe higher levels of gi nse ng or irs 2002 HerbaiGram 54 49 ginsenosides, at least if o ne can obtain high-quali ty ginseng In sum, ginseng has a lo ng hisrory of use in Asia that has roots. Ginseng root powder at 500 mg per capsul e wi ll pro generated interes t in continuing the tradition inro the pres vide 3 grams of ginseng in just six capsules (e.g., three cap ent and in studying, by modern methods, the constituents of sules, two times per day). In addition, ginsenoside-ri ch ginse ng and their pharmacological and clinical effects. A extracts from P ginseng are prepared in C hina with 20-85 careful reading of both the traditional li terature and modern percent ginsenosides (to get the higher ginsenoside concen Asian and Western research efforts is essential ro help guide trations, ginseng leaves and/or fruits are used as a source consumers and healrhcare professionals rowards knowing the material), making it easy ro get a desired amount of ginseno correct indicatio ns and dosages for ginseng, selecting appro sides into a single capsule. T hese concentrated ginsenoside priate ginseng materi als to use, and avoiding unsubstantiat extracts have been subjected ro clinical evaluations in C hina, ed claims. -"' particularly for elderly pati ents who may have trouble con Subhuti Dharmananda, Ph.D., is the director ofthe Institute suming large amounts of capsul es or tablets. '' ' [Editor's note: for Traditional Medicine (I TM), in Portland, Oregon, and A summary ofginseng dosage recommendations .from 12 litera author ofseveral books and articles on Chinese medicinal herbs. 60 ture sources was recently published in this journa/. ] H e has studied Chinese herbs and herbal products for more Summary and Concluding Remarks than 25 years and was one of the first American scientists per mitted to enter the People's Republic of China for herbal In this article, the author has attempted ro reveal the tradi tional understanding and uses of Asian ginseng (Panax gin research in the late 1970s. Further information of traditional seni), irs usual recommended dosage, the type and levels of and modern uses of herbs can be found on the I TM website active constituents found in ginseng, and the complex situa o The usual recommended dosage of ginseng in Asia is which overlap.] most often in the range of 3-9 grams/day. By contras t, 5. Hsu HY, Wang SY, translators. Chin Kuei You Lueh. Long Beach (CA): Orienta l Hea ling Arts Institute; 1983. herb product manufacturers in the Wes t may recom 6. Huang BS , Wa ng YX, compilers. Thousand Formulas and mend using fa r less, with amounts that are of ques tion Thousand Herbs ofTraditional Chinese Medicine. Harbi n: Hei able potential ro provide any of the des ired ginseng longjiang Ed ucation Press; 1993. actions. 7. Bensky D, Barolet R. Chinese Herbal Medicine Formulas and o The primary active constituents in various species of Strategies. Searrle (WA): Eas tland Press; 1990. Panax are saponins call ed ginsenosides. T he concentra 8. Ph armacopoeia Commiss ion of PRC. Pharmacopoeia of the People's Republic of China (1988 English Edition). Beij in g: tion of ginsenosides in ginseng roots reported in the lit Peo ple's Med ical Pub lishing House; 1988. erature varies considerably. European researchers report 9. Ming 0 . Chinese-English Manual of Commonly Used Herbs in lower levels than their Asian counterparts. The concen Traditional Chinese Medicine. Hong Kon g: Joint Publishing tratio ns also va ry according ro the species of ginseng and Company; 1989. irs method of preparatio n. Based on the C hinese rec I 0. Unschuld PU. Medicine in China: History of Pharmaceutics. o mmendations for dosage of the roots - and for the Berkeley (CA): University of California Press; 1986. dosage of isolated ginsenosides that are sometimes given I 1. Hu SY. Knowledge of ginseng from ancienr records. journal of in clinical studies - the amount of ginsenosides to be the Chinese University of Ho ng Kong 1977;4(2):285-305. 12. Unschuld PU. Forgotten Traditions of Ancient Chinese Medi taken in one day would typicall y be about 80-240 mg cine. Brookline (MA): Parad igm Publications; 1990. for long-term administratio n (several weeks o r mo nths) . 13. Chen KJ. The effect and abuse syndrome of gin se ng. j Tradit European recommendatio ns for dosage of ginseng and Chin Med 1981; 1( I ):69-72. for the ginsenosides are much lower. 14. Furrh C. A Flourishing Yin: Gender in China's Medical History. o Modern research into ginseng and its effects has 960-1665. Berkeley (CA): Univers ity of Cali forni a Press; been hampered by poor q uality in study des ign and 1999. p 229. 15. Unschuld PU. Introductory Readings in Classical Chinese Med reporting. As a result, many phys icians and icine. Dordrecht, Netherlands: Kluwer Acade mi c Publishers; researchers do not find the effects that have been 1988. reported to have a credible basis. T he research 16 . Dixon P. Ginseng. London: Gerald Duckworth and Company; efforts have largely been fo cused on anti-fatigue 1976. acti o ns and reductio n of risk factors for cardiovascu 17 . Hou JP. Ginseng: The Myth and the Truth. Norrh Hollywood lar diseases (including diabetes, which often leads ro (CA): W il shire Book Company; 1978. cardiovascular complications), though other areas of 18. Zhang EQ, editor. Rare Chinese Materia Medica. Shanghai: interest have been pursued (e.g., radioprotective and Publishing House of Shanghai College of Traditional Chinese Medicine; 1990. chemoprotecrive effects). 19. Ling YR. A New Compendium ofMateria Medica: Pharmaceu- 50 HerbaiGram 54 2002 tical Botany and Chinese Medicinal Plants. Beijing: Science seng root. In: Proceedings of rhe 2nd International G inseng Press; 1995. Symposium; 1978; Seoul, Korea. Seoul: Korea Ginseng 20. Bremer K, C hase MW, Stevens PF. The angiosperm phyloge Research lnsrirure; 1978. p. I 09- 14. ny group: an ordinal classification for rhe families of flowering 45. Liberti LE , Der Marderosian A. Eva luation of commercial plams. Annals of the Missouri Botanical Carden ginse ng products. j Pharm Sci 1978; I 0:1487-9. 1998;85(4):53 1-53. 46. Meier B, Meier-Bratschi A, Dallenbach-Tolke K, 2 1. Tang W, Eisen brand G. Chinese Drugs ofPlant Origin. Berlin: Sticher 0. Quanritative analysis of ginseng by Springer-Verlag; 1992. HPLC. In : C hang HM, Yeung H W, Tso WW, Koo 22. C hang HM, Bur PPH. Pharmacology and Applications ofChi A, edirors. Advances in Chinese Medicinal Materials nese Materia Medica. Singapore: World Scienrific Publish ing; Research. Singapore: World Scientific Publishing; 1986. 1985. p. 47 1-84. 23. Smith FP, Sruarr GA. Chinese Medicinal Herbs. Sa n Francisco: 47. Sandberg F. The analytical problems involved in the Georgerown Press; 1973. gi nseng products on the gin se ng market. In : Bae H W, 22. Bae HW, ed itor. Korean Ginseng. Seoul: Korea Ginseng ediror. Proceedings of the 2nd lnrernati onal Gi nseng Sy mpo Research lnstirute; 1978. sium, 1978; Korea Ginseng Research Institute, Seoul , Korea; 25. C hen SE, Sawchuk RJ , Sraba EJ. Pharmacokineti cs of ginseng pp. 4 1-2. compounds. In: Proceedings of the 2nd Inrern ario nal Ginseng 48. Vogler BK, Pirrler MH, Ernst E. The efficacy of ginseng: A Symposium, 1978; Korea G inse ng Research lnsrirure, Seoul, systematic review of randomised clinical trials. Eur j Pharma Korea; pp.55-6. col 1999;55:567-75. 26. Hou JP. The chemica l consriruenrs of ginseng planrs. Com 49. Eisner S, editor. Guidance for Manufacture and Sale of Bulk parative Medicine East and W't>st 1977;5(2): 123-4 5. Botanical Extracts. Silver Spring (M D ): American Herbal 27. Cao H , But PPH, Hu SY. The ginseng plants: commercial Products Associati on; 200 I. products and quality assess ment. Chung Kuo Chung Hsi I 50. Brown DJ. Herbal Prescriptions for Better Health. Rocklin Chieh Ho Tsa Chih (Chinese journal of Integrated Traditional (CA) : Prima Publishing; 1996. and W't>stern Medicine) 1997;3(4):306- 10. 51. Bahrke MS, Morgan WP. Evaluation of ergonogenic proper 28. Tanaka OM, Kasai RJ , Morita TN. C hemistry of ginseng and ties of ginse ng: an update. Sports Med 2000;29(2}: 113-33. related planrs: recent adva nces. Abstracts of Chinese Medicine 52. Vogl er BK, Pirrler MH, Ernst E. The efficacy of ginse ng: a sys 1986; 1 ( I}: 130-52. tematic rev iew of randomised cl inica l trials. Eur J Clin Phar 29. Wang R, Ren SJ, Lien EJ . Chemical and clinical inves ti ga tions macol 1999; 55: 567-75. of gi nse ng: a survey. International journal ofOriental Medicine 53. Soldati F. Panax gi nseng: Standardization and Biological 1999;24(2):57-84. Ac ti vity. In : Curler SJ, Curler H G. Biologically Active Natural 30. Courr W. Ginseng: The Genus Panax. Amsterdam: H arwood Products: Pharmaceuticals. Boca Raron (FL) : CRC Press; 2000. Academic Publishers; 2000. p. 209-32. 3 1. Soldati F, Sticher 0. HPLC separation and quantitative deter 54. H an KH , C hoe HS, Sohn DW, Nam KY, Oh HB, Lee MM, mination of gi nsenosid es from Panax ginseng and Panax quin er al. Effects of red ginseng on blood pressure in pati ents wirh quefolium and ginseng drug preparations. Planta Med essenrial hyperrension and white coat hyperrension. Am j 1980;39:348-67. Chin Med 1998;26(2}: 199-209. 32. Hsu HY, Chen YP, Shen SJ, Hsu CS, C hen CC, C hang HC. 55. Dharmananda S. Panax ginseng. A clinical srudy of irs effects Oriental Materia Medica. Long Beach (CA}: Oriental Healing on ri sk factors of cardi ovascular diseases. Bulletin ofthe Orien Arts lnstirure; 1982. tal Healing Arts Institute 1983;8( I): 1- 13. 33. Bradley P, editor. British Herbal Compendium: A Handbook of 56. Juan JQ, Guo WZ, Yang BJ, Zhou YX, Liu P, Wang QX, er al. Scientific Information on Widely Used Drug Plants. London: 116 cases of coronary angina pecroris treated with powder British Herbal Medicine Association; 1992. composed of ginseng, noroginseng, and succinum. j Tradit 34. Chuang WC, Wu HK, Sheu SJ, Chiou SH, Chang H C, C hen Chin Med 1997; 17( 1}: 14-7. YP. 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Am j Chin of Integrated Traditional and Western Medicine) Med 1973; I (2}:249-6 1. 1990; 10 ( I 0):586-9. 41. Hedady L. Asian Health Secrets. New York: Three Rivers Press; 63. C hang YS, Lee JY, Kim CW. The effect of ginsenos ide-rriol on 1996. rh e posroperarive recovery in gynecological patients. In: Pro 42. Siegel RK. Ginseng abuse syndrome. jAMA ceedings of rhe 2nd lnrernarional Ginseng Symposium, 1978; 1979;24 1(15}: 16 14-5. Korea Ginseng Research lnsrirure, Seoul , Korea. 43. Blumenrhal M. Debunking the "ginseng abuse syndrome." Whole Foods 1991 March:89-9 1. 44. Sairo HS, Lee YM. Pharmacologica l properries of Panax gin- 2002 HerbaiGram 54 51 Remembering VarroTyler The medicinal plant and pharmacognosy communities suffered an immense blow with the sudden death ofVarro E. "Tip" Tyler on August 22. Professor Tyler was a true giant in the field of pharmacognosy and herbal medicine education in the U.S. and abroad. Herbal Medicine at the Crossroads: The Challenge of the 21st Century by Vtmo E. Tyler, Ph.D. , Sc.D. he fo llowing is an edited transcript of a presentation given by Bur I think rh ar rh e principal reason rhar people use herbal med D r. Tjler at the july 10, 2001, NutraCon Conference, spon icines is rhar they are very mild in their effects- yo u have to have Tsored by New Hope Natural Media in San Diego, California. a little patience to use them pro perly; it may take several weeks, or This last major address before his death in August 2001 was original even months, to be effective- and they have ve ry few, very mild ly entitled "From Boom ro Bust ro ???: T he Role of side-effects. And most of the adverse reactions are Science in Resurrecting Narural Product Sales and generally quite mild. If yo u have an al lergy ro C redibility," but Prof Tyler later changed it as it chamomile, yo ur nose is going to run and yo ur eyes appears above. This presentation has been edited slight are go ing to water, but yo u're not go ing to ge t the ly. with Latin binomials added where appropriate- in anaphylactic shock that could come with penicillin. keeping with Prof Tjler's preferences - and other It's unnecessary fo r me to review the current laws minor edits, including the addition ofreferences, drawn and regulations, because yo u members of industry from citations on his presentation or from ABC's library. are much more familiar with the Dietary Supple HerbaiGram is grateful to New Hope Natural Media ment Health and Educatio n Act of 1994 (OSH EA) for making available the tape ofth e speech and to Linda than I. You recognize that this law allowed herbal Michael, Tyler's executive assistant for over 15 years at products to be sold as foods - as dietary supple Purdue University, for transcribing it. ments - and they fall into the "Food" category. 'm going to talk about "H erbal Medicine at the There were some provisions for good manufacturing Crossroads: T he C hallenge of the 21st Century." I practices (GMPs); now the GMPs for conventional I Prof. Varro E. "Tip" Tyler like this ride because it gives me a chance to use Yogi ( _ ) foods apply. But the FDA has been involved for 1927 2001 Berra's favo rite line, "When yo u co me to a fork in nearly seven years in developing specific GMPs fo r rhe road, rake it. " His point is nor to stand at rhe herbal products, and they have not yet been final crossroads roo long, otherwise the bus wi ll go by without yo u. ized. Label claims, of co urse, are res tricted. You can't make a ther- The most-asked question I get when people learn of my interest apeuti c claim; so in many cases, the consumer who uses the prod in herbal medicine is, "Why do we use these things; I mean, in this uct doesn't really know what it is good for. And no qual ity stan age of all of rhe antibiotics and srari ns and rriprans and bioengi dards were established. T hat was the biggest failing of OSHEA, in neered drugs, why do people use herbs for health care?" I think it's my opinion, because it allowed inferior products to appear on the important for us to rev iew these reasons because then we can see marke t. how well we are meeting them. As a res ult of this, the market has declined precipitously in the In rhe 1960s, of course, there was a back-to-nature movement. last two years. It reached a 1998 high of $3.87 bi ll ion. Then the Natural lifestyles and organic products became important to peo mid-year sales in 2000 were down about 12 percent, on average, ple, and that was when the herbal movement really starred. T here and in 2001 more than 15 percent.' Some specific herbal products are, of co urse, problems with our healrhcare system - it's di fficult and their decline in sales by mid-year 2000 include: garli c down 12 to access, very impersonal, people don't like to be involved in it. percent, and ginkgo down by 22 percent. And, of course, St. John's And so that's another reason, because peopl e now like to rake wort (Hypericum perforatum L., Clusiaceae), with all of the adverse greater res ponsibility for their own health. Also a lower cost is publi city about drug interacti ons, ere., leads the list in decline: involved, although most herbal products are nor reimbursable by Facing page: Varro Tyler at the Explorama Lodge in the Peruvian Amazon during most insurance plans. ABC's first Pharmacy from the Rainforest ecotour in 1994. Photo © 1994 lan Hunter 52 HerbalGram 54 2002 down about 4 1 percent. Only saw palmetro was up because so me very good U.S. clinical ip was my mentor because of who he studies on saw palmetto, and a good review of Twas as a person. He was a gentleman them in the journal of the American Medical who was kind and considerate with other Association, led w a sli ght increase in sales of people, but also let his opinion be known. He was strong enough to hold unpopular this interes ting product. ' opinions, but gentle enough to be open to The reasons for rhe marker decline are sev others. It is his guidance that I miss. But, in eral. For one, variable product quality. Prod remembering him, I know that I will con ucts ranging from truly excellent w absolute tinue to learn from the example he set. junk have discouraged many people from Here's to you, Tip! We will miss you! consuming herbs. And negative publicity in the popular and rhe profess ional press has Marilyn Barrett, Ph.D. also, in my opinion, played a very important Pharmacognosy Consulting Service role. I want w emphasize that not all of the San Carlos, California negative publicity in the popular press is due w the science writers. Actually, very signifi what rh ey wrire about. cant fau lty interpretations of clinical res ults Ler me jusr poi nt our so me of rhe variable of studies are also made by clinicians. T hey product quality issues: ephedra (Ephedra sini view these products in the sa me light as ca Stapf., Ephedraceae), 0- 154 percent of approved drugs with standards of quali ty. In label claim; ginkgo (Ginkgo biloba L., many cases, the adverse events or adverse out Ginkgoaceae), 6 of 30 products did nor meer comes that are reported in clinical studies are rhe established qualification on the label; gin due w the fact that the cli- se ng (Panax ginseng C.A. nician was nor usin g a The tributes from Prof. Tyler's Mey., Araliaceae) , an enor proper product and made many friends and colleagues here mous vari ati on in ginseno no effort w determine if the in HerbaiGram have been edited sides - no one reall y product was actually what for space. The full tributes may be knows whar rhe proper dose ir was identified initially to found on ABC's website of ginse nosides or ginseng be. I'm going to discuss rh ar 54 Herba!Gram 54 2002 and 40 servings would be required to get a may have been adulterated with some steroid. beneficial dose of the ginseng. So the ques The conclusion is , therefore, that a misiden tion of therapeutic dose creates real prob tified substitute herb was probably adulterat lems in that particular field . ed with an androgen. But you still find quo Now, let me give you a few examples of tations in the literature pointing out that gin (Panax incorrect negative publicity. I'm going to take se ng species) has an androgenic activ these one by one: the Hairy Baby Case in ity, which, of course, it does not. Canada, the garli c/cyclodextrin tablet situa tion, the "echinacea worthless in preventing is lectures, writings, dry wit humor, colds" situation, herbs contaminated with H and broad range of interests truly rep animal tissue, and, finally, valerian wi thdraw resented the best of a classical naturalist. al causing delirium. His memory sustains me even today in all of my daily historical, botanical, and chem ical forays into our natural world of botan ical wonders. mmediately upon meeting this amazing I gentleman, I knew I wanted to adopt him Ara Der Marderosian, Ph.D. as my grandfather. This was a man charis Professor of Pharmacognosy and Medicinal matic without electricity. This was a man I Chemistry wanted to get muddy with in the Amazon Roth Chair of Natural Products Scientific Director, Complementary and Rainforest. He said yes! Alternative Medicine Institute He will be sorely missed by all who loved Institute of the Sciences, him as teacher, mentor, researcher, leader, Philadelphia, Pennsylvania friend and most of all, as a true gentleman and outstanding human being. Now let's look at some headlines with Charlotte de Frances respect to garlic, and particularly ga rlic oil. The Associated Press said that this study "Pharmacy from the Rainforest" Ecotour Founder and Leader "Nixes ga rli c as an aid to lower cholesterol;" Helena, Alabama United Press International said "Garlic has no effect on choles terol;" and the Los Angeles We're going to start with the Hairy Baby Times said "Garlic pills call ed 'useless' for cho Case in Canada, but first of all, let me remind les terol." And this all came about because a you that there is a distinct difference berween 1998 paper in }AMA by German au thors- a eleuthero (Eieutherococcus senticosus (Rupr. small, double- blind, controlled, crossover trial and Max im .) Max im ., Arali aceae), which is with 25 subjects- used steam-distilled garlic now the accepted name for what we used to oi l tableted with betacyclodex trin to deter call "Siberian ginseng," and gi nseng itself, mine if it reduced blood lipids. - The authors which is a Panax species. So, the H airy Baby concluded, as a result of their study, that gar Case in Canada dates back to 1990: a moth lic therapy for the treatment of hypercholes er gave birth to an es pecially hirsure infant. terolemia cannot be recommended on the T he phys icians reported, therefore, that the basis of this study. And th at is ce rtainly true, ginseng that she had been taking had an but that isn't what the headlines said . They androgenic effect. ' Actually, she wasn't taking said garl ic was worthless. It was later deter ginseng at all! T he attending clinicians did mined that, in the first place, ga rli c oil isn't not recognize the difference betwee n very effective in cholesterol reduction because eleuthero, which she was presumably taking, the allicin in it has bee n converted by distilla and Asian ginseng (P ginseng). However, tion to diall ylsulfides, whi ch are much less analysis of the product showed that it was not active. Sixty-four percent of th e oil was never even eleuthero, but Chinese si lkvine (Peripfo released from the tablets, and the tablets 4 themselves disintegrated poorly in the gas ca sepium Bunge, Asclepiadaceae). ' C hinese si lk vine has a similar name in C hinese to trointestinal tract.' Very, very little of the gar Efeutherococcus, and was therefore substituted li c oil was ever released and abso rbed into the for it. But the problem - the conundrum, as sys tem. If yo u are going to say anything about our lawyer fri ends would say - was not that this study, say that the res ults apply specifical Eleutherococcus caused this problem or that ly to distill ed ga rli c oil tableted with betacy Periploca sepium caused it because neither of clodextrin . But that isn't what the headlines them is androgeni c.'' Poss ibly, the silk vine read; they read that ga rli c was worthless. Stages in Tyler's personal life, top to bottom: Young Varro poses in his Boy Scout uniform in the back yard of his family home. Tyler stands by a statue of the Buddha in Japan (ca. 1945). Sgt. Tyler was on the first sh1p to land in Japan after the end of World War II. Professor Tyler with his family (left to right. daughter Jeanne. wife Ginny. son David) in their L1ncoln. Nebraska. apart ment. shortly after he JOined the faculty of the University of Nebraska. Photos courtesy of the Tyler family. 2002 Herba!Gram 54 55 was always impressed with Tip's ability to speak so well, but I this is one trait that I was never able to match. I often described him as ''A person who could sell a blind man a television set with the audio on the blink." He never disagreed with this characteri zation. After Tip retired from being Provost of Purdue University, he took on the task of writing a monthly article in Prevention mag azine and became the most recognizable pharmacognosist in American history. His writings were scientifically accurate, albeit somewhat conservative in content. I can only imagine that Tip is now in Heaven, learning to play the harp, and educating the angels on the benefits of herbal medicines. Norman R. Farnsworth, Ph.D. Research Professor of Pharmacognosy Tyler sitting on his favorite bench on the banks of the river Moselle, enjoying the College of Pharmacy, University of Illinois at Chicago region's wine. The Tylers visited Germany every September - ameliorating those symptoms - but not in preventing them Another one that I enjoy very much because it points out the from occurring. So he was using the wrong product, or an inferior extremely poor refereeing, or peer reviewing, that takes place in product, to test a thesis that was invalid in the first place. even in so me of our best medical journals when it comes to herbal Tincture of valerian ( Valeriana officina/is L., Valerianaceae) is papers. This wonderful item came out as a letter to the editor of particularly interesti ng because valerian was at one time an official the New England journal ofMedicine, stating that "herbal supple drug. There is a case report of an individual who was taking a very ments" may be contaminated with animal tissues! The letter writer large number of drugs prior to surgery; and then he underwent complained about this; but careful reading of the letter shows that anesthesia with several different anesthetics. During his recovery the "herb" he was talking about was not an herb at all, but a glan period, he went into a delirious state. Instead of blaming all of the dular ex tract. And it, of course, is no surprise to me - and it drugs that were not taken following the surgery, instead of blam should not be to the readers of New England journal of Medicine ing the anesthetics that were employed, the attendant physician - that animal products could be contaminated with animal tissue. jumped to the conclusion that it was the lack of taking his valerian But, nevertheless, it was an extremely misleading story, which was that caused delirium." Obviously, there is no relationship between picked up by so me of the press. the two, but this is the kind of thing that happens. And, inciden tally, the physician made no effort to analyze the valerian product 've enjoyed of Tip's wisdom and humor on three continents: to determine if it really was valerian in the first place. Remember, I Australia, North and South America. I said they often take these things for granted as if herbal products His first big herbal book, The Honest Herbal, offended some of are standardized, approved drugs. the clinical American herbalists. But if they compare the second edition and especially the third, they will find that he was evolv he thing I honor and respect most about Tip was not his ing more and more towards a phytochemical and sometimes Tmany publications, nor his many contributions to pharmacy, even a pro-herb stance. He, as much as anyone, is responsible for nor his leadership at Purdue University, nor even his defining a the name Commission E meaning more in America than perhaps clear agenda for the role of natural products in today's health it means in Germany. care environment, but that through it all there was always some Jim Duke, Ph.D. thing of the small town Nebraska farm boy in Tip - a quality that Economic Botanist USDA (Retired) gave him a humanness and kindness seldom found among those Green Farmacy Garden sharing the rarified atmosphere of academic and scientific Fulton, Maryland acclaim. Tip was truly a gentleman and a scholar. Michael A. Flannery Echinacea was declared worthless for preventing colds. A clinical trial showed that echinacea did not protect subjects from rhi Associate Director for Historical Collections University of Alabama at Birmingham novirus colds, and the author reponed that his product contained 0.16 percent cichoric acid but practically no alkamides or echina coside."' One of my colleagues queried the author as to what prod If herbs are to make a comeback from this decline, this precipi uct was used in the study, because this description didn't fit any of tous decline in the last couple of years, I think that there are four them, and he said he didn't know. He used a product that was fur necessary requirements. First, there has to be absolute proof ofsafe nished to him by the company that sponsored the research. So we ty of the products - and when I say "absolute," I mean absolute called up the company that sponsored the research. They indicated in the nearest sense. Nothing is absolute, of course, but I think that that they had purchased this product - without analysis - from as close as you can get to absolute is necessary. Then there has to a company in the U.S. Of course, all we could conclude was that be proof ofreasonable certainty ofefficacy. What do I mean by that? there isn't any such quality echinacea preparation; and obviously, he Well, the drug companies tell us that, to prove a new chemical was using a very inferior preparation; also obviously, it didn't work. entity effective takes up to half a billion dollars. Obviously, no one In the first place, he was testing the wrong thing. No one ever said, is going to invest that amount of money in an unpatentable herb at least in terms of verification, that echinacea would prevent colds. for which no market excl usive is available. By reasonable certainty Echinacea has a good track record, at least certain products do, in ofefficacy , I mean a couple of small clinical trials at least that might shortening the duration of the symptoms and in modifying those account for as much as $1 million, bur nothing more than that. I 56 HerbaiGram 54 2002 don't think it's necessary to make that investment in these long product, one milk thistle product, three St. John's wort products used products. (o ne of those has since been withdrawn from the market; the com Next, there has to be quality assurance ofspecific herbal products, pany terminated its herbal venture), two saw palmetto products, and this is an enormous stumbling block today. Qualiry assurance and one product fro m red yeast (Monascus purpureus Went., was not part of OSHEA; that is, a company does not need to meet Monascaceae). Of course, red yeas t rice is now withdrawn from the a particular standard of proof of identiry or qualiry in order to mar market because of regulatory action and litigati on. ket a product or meet a structure/function claim . Many compani es So, of all of the thousa nds of herbal products on the American have not necessarily paid a great deal of attention to it. But it is one market, this handful is based upon true science. T he rest are based of the true stumbling blocks because it has caused a lot of erro upon what we call "borrowed science" or, in some cases, no science neous reports and a lot of usel ess consuming of herbal products. at all. I recognize that this is not a popular thing to say, but I wo uld hope that so me of the effort to counteract the negative publiciry that herbs have garnered in the past yea r or two, that so me of that r. Varro (Tip) Tyler had a major impact on my career devel D opment. I had applied for admission to several medical money could be used not just for (and I don't use the term in a schools and was confident that I was about to embark upon an pejorative sense) propaganda, but would also be used to obtain sci academic journey that would lead to a career as a physician. entific data supporting the efficacy of these products. I think that However, I first met Tip during that April of 1966. He was visit would be a ve ry great step forward , and I would urge those who are ing Idaho State University as an AACP touring lecturer and, of considering some of these efforts to use some of the funds raised course, he delivered a powerful seminar on medicinal and poi for that particular purpose. sonous mushrooms. I was fascinated with pharmacognosy pri marily because of Tip's enthusiastic delivery. After his presenta r. Tyler, or "Tip" to those who were his friends, was some tion, Tip spent nearly three hours with me talking about his D times referred to as one of the fathers of modern pharma favorite discipline and discussing career opportunities. Tip was cognosy. He was not only a pioneer in this country, but a giant in so engaging, convincing, and persuasive, that I decided to join the field of pharmacognosy and herbal medicine education him and pursue pharmacognosy as a career discipline. After internationally; he played a significant role in the recent revital earning the Ph.D., I entered academia and enjoyed professorial ization of the field in the U.S. His knowledge base was great and positions for 30 years before assuming my present position in the he was always available to help with questions, give advice and his herbal industry. seasoned opinions. For me, Tip's presence as a mentor and a fatherly resource will A most gracious, generous, gentle man, Dr. Tyler always had a be sorely missed. smile and his characteristic soft laugh. In recent years, that served William J. Keller, Ph.D. him particularly well as he faced treatment for multiple myelo ma. Dr. Tyler never ceased to encourage and mentor those of us Vice President, Health Sciences and Educational Services Nature's Sunshine Products, Inc. who are trying to follow in his footsteps and convey accurate information on botanical medicine. Formerly: Professor and Head, Division of Medicinal Chemistry/Pharmaceutics, My colleague, Dr. Tieraona Low Dog referred to Dr. Tyler as Northeast Louisiana University Wicasa waonspe - Lakota for "a learned man." As she so aptly Professor and Chair, Department of Pharmaceutical Sciences, said: "There are many words, but this is reserved for those who Samford University are learned and wise; Dr. Tyler was one of the few people deserv ing of a truly respectful formal address that I couldn't bring And, finall y, the claims made for the products must be accurate. myself to call him by his nickname, though he asked me to on There has to be truth in advertising, and this is an enormous prob numerous occasions." lem. One of my co ll eagues likes to say that the marketing is way While we are greatly saddened by this premature loss, and will ahead of the science; unfortunately, that is true; and I think it has greatly miss him, we are all the better for his having been here gotten us, in large measure, into the trouble that we face today. and having paved the way for the maturing and coming of age of Let's look at some of these things. Proof of safery and efficacy. herbal medicine for the 21st century. This remains a problem because efficacy proof is ex tremely ex pen Fredi Kronenberg, Ph.D. sive. It requires randomized human clinical trials for single chemi Director, Rosenthal Center for Complementary and cal entities- new synthetic drugs - which can range up to about Alternative Medicine half a billion dollars. We don't need that much proof for these College of Physicians & Surgeons, Columbia University long-used herbal products, but most companies in the industry Excerpted from: In Memoriam: Dr. Varro Tyler: 1926-2001 In: The journal ofA lternative and Complementary Medicine 2001; have been loath to invest in the necessary studies, and onl y a few 7(5):603-4; 2002 HerbaiGram 54 57 do now that it is no longe r sold in the U.S. -green tea (Camel ne of "Dr. T's" top tenets was, "The worst possible decision Lia sinensis (L.) Kuntze, Theaceae) and St. John's wort. The Uni is no decision at all." Situations requiring his attention were versity of Illinois at Chicago is featuring women's health. I know O never settled by default. they're working a great deal on black cohosh (Actaea racemosa L., Ranunculaceae syn. Cimicifuga racemosa (L.) Nutt.) there and That applied to his professional life, too. Standing front-and already have some extremely interes ting results about irs non-estro center in the herbal remedy field - chided as a chemist by "true genic mode of action. The University of Arizona is concentrating herbalists" and given near witch-doctor status by his "chemistry on Ayurvedic Medicine and inflammatory diseases; and my own only" academic colleagues - he made a perfect target for the barbs of those on either end of the spectrum. Still, I watched in institution, Purdue University, is working with AIDS-related dis wonder as he one day made the conscious decision to take that eases and particularly the polyphenols and ca lcium, as well. So, position; and once taken, he stood his ground. rhar is a bright spot in the research area of herbal products. This was an honorable and decent man, the consummate gen arro will always remain in the minds and memories of those tleman-and-scholar. It was my great good fortune and privilege V who knew him as an exceedingly special person who pos to serve as his assistant for 15 years, as his friend for 20. Our plan sessed a quality of scientific insight surpassed by few. Pharma et is poorer for Varro Tyler's passing, true. But we - you and I cognosy and all related fields have lost a positive visionary, and - are so much richer for his having been here. all in these disciplines a colleague and friend. Linda Michael Walter H. Lewis, Ph.D. Dr. Tyler's executive assistant, Purdue University Professor of Biology, Washington University and Senior Botanist, Missouri Botanical Garden example of ga rli c oil being rableted with betacyclodextrin, which rendered ir essentially inactive. So excipients and coatings are As ye t, little progress has been made in the area of quality assur important. For example, in the case of some types of garlic tablets ance. The development of good manufacturing practices (GMPs) that have to get into the small intestine so the alliinase will not be for herbs, which was authorized by OSHEA, is still not finalized; destroyed by stomach acid in order for the product to be effective, they have been worked on since 1995. The development of herbal the enteric coating enables the tablet to provide rhis activity. In monographs by the U.S. Pharmacopeia is of interest; USP is addition, there are numerous issues regarding the production of preparing monographs on 50 herbs, and 19 of those monographs the tablets, capsules, extracts, etc. Al l of these factors must be con are already completed. I salute USP for that excellent ac tivity. Bur sidered in terms of quality. the current law provides few standards, and I think it is the great est failing of OSHEA. OSHEA did so me good th ings, bur it also hen I was a pharmacy student in 1960-61 at Michigan, Tip had so me serious failings, and the lack of quality assurance was one W Tyler visited and lectured to us about ergot, morning glo ries, and magic mushrooms. A career of future work in the search of them. for new bioactive principles in plants and mushrooms was made clear to me. Without Tyler's lecture, I would, undoubtedly, not be s a Nebraskan he inherited "in spades" the eloquence of a a pharmacologist today. My move to Purdue in 1971 was due to A19th century Nebraskan politician - William James Bryan Tyler's encouragement, and his administrative support there - enabling him to become the leading spokesman for American helped us to elevate Purdue to become a mecca for natural prod pharmacognosy. Tip was the Victor Hugo of popular and scien ucts research. Tip's wise counsel will be surely missed in both my tific phytomedicinal writings. He opened people's minds world personal and professional life. wide as to the meaning and dignity of pharmacognosy, and as well the potentials and limitations of medicinal herbs. His wis Jerry L. McLaughlin, Ph.D. dom of the plant sciences, particularly the fungi, was probably Vice President - QNR&D/CSO, Nature's Sunshine Products Emeritus Professor of Pharmacognosy, Purdue University equal to Pliny's knowledge of the Natural Sciences. The accuracy of his forecasts have exceeded that of Nostradamus; at least, with respect to the complexities and health value of dietary supple The FDA las t year published a guidance document for the ments, deficiencies of some government organizations, and the botanical industry, to allow approval of these products as drugs by blindness of most manufacturers to the purpose of meaningful two different routes. "·13 One would be an ex pansion of the over product standardization and research leading to new drug dis the-counrer monograph system, and the other would be the usual covery. IND-NDA (Investigational New Drug-New Drug Application) E. John Staba, Ph.D. procedure that is used for all new drugs. The first drug in a partic Emeritus Professor of Pharmacognosy ular category to receive approval by th is latter process would get a College of Pharmacy 3-5 year market exclusive- kind of a junior parenr, if yo u will University of Minnesota on that particular category. So there is a bit of a carrot there. How eve r, it is impossible to say if either of these routes is viable because 1 want to point out that quality ass urance does nor begin and end the FDA did not specify the degree of evidence that would be with the final dosage form. lr involves a lot of things, including required by either method to prove rhe product safe and effective selection of the plant material for cultivation; the genetic compo as a drug. And until we know, until some product has passed and si tion of the plant material is extremely important. lr deals with we have the opportunity to look ar the data that were supplied to culrivarion and harvesting practices; the use, for example, of pesti the FDA in order to support that claim, we won't know whether cides to control fungi and insects can be a real problem during the either of these routes to drug approval is viable or not. So it still cultivation. Ir includes how rhe plant material is dried and milled; remains up in the air. ir includes ex tracti on, assay, and standardiza tion of rhe material. lr Now, it's obvious that additional regulations are needed to assure also includes the design of rhe dosage form. Keep in mind my qual ity. My discuss ions with many producers and marketers reveal 58 HerbaJGram 54 2002 substantial support for regulations that would ass ure qualiry herbal physi cia ns; products. I don't think there is any other alternative. We have to they are sold do something. The status quo is not acceptable; self-regul ation has in pharma nor worked, and something must be done to make ce rtain that the Ci es, and public health is safeguarded and the public pocketbook is safe- so me prod ucts (for hat I will miss about Tip Tyler: That wonderful, deep, clear exa mpl e, W voice at History of Pharmacy meetings. He always used teas, etc.) history to make a practical point, and listening to his discussion that make you wondered why more people didn't study pharmacognosy. mild claims History seemed vibrant and alive in his hands. And he used it to are sold in bring reason and perspective to complicated and sometimes hea lth fo od flamboyant discussions of modern issues with plant drugs. Even stores as as he used history as a stabilizing influence, he was always for well ; the ward thinking about how to apply these ideas to the present and G e rm a n to the future. We can continue to read his words, but the sound pharmacists of his voice will be sorely missed. and phys i Elaine Stroud, Ph.D. cians lea rn American Institute of the History of Pharmacy about them Madison, Wisconsin during their aca d e mi c guarded by the assurance that they will receive qualiry products. caree rs and How can we do this? In my opinion, Germany has the ideal regu are able to Tip and his wife. Ginny. on the road between Cuzco and latory system in the world today. It's probabl y going to undergo in tell igen rl y Machu Picchu in the Peruvian Amazon. 1996. Photo courtesy of the Tyler family. some modification due to "harmoniza tion" among the Europea n counsel or Uni on; bur at rh e moment, rhe German sys tem is quire good. T he pr esc rib e herbs or botanicals - or phytomedicines, as they are referred to these products for use by th e particul ar patient. T he system there - are approved as drugs with quali ry standard s based on encourages intelligent use and cost savin gs because many of th ese absolute proof of safery and a reasonable proof of effi cacy. T he products - not all , bur some - are reimbursed by the German Commiss ion E, a body appointed by the German equivalent of our federal gove rnment, and the need for evidence ensures that so me FDA but not a part of that organization, determines that safery research, some clinical study, is goi ng to be carried out on th ese and effi cacy. The products are recommended and prescribed by products. Revised and Expanded Third Edition Herb Contraindications and Drug Interactions by Francis Brinker, N.D. The best book on the market explaining documented herb contraindications and drug interactions is now even beuer! • Number of herbs addressed expanded to 240 • Categorizes herb-drug interactions by type of supporting research (human studies, animal research, in vitro, speculative) • Extensive appendices addressing specific conditions, herb effects, criti cal medications, and nutritional supplements • Free regular updates available online at www.eclecticherb.com/emp Softcover, 432 pages. $25.95 Catalog item #B282 To order, call toll free 800/373-7105, fax 512/926-2345, email: [email protected] or order online at www.herbalgram.org 2002 HerbaiGram 54 59 Let's look at the final requirements for a successful herbal come back: product claims must be accurate. Responsible marketing is a key item here. It's no secret that marketing personnel, not scien tists, control the policies of many herbal companies, and this has go tten us into a great deal of trouble. It has res ulted in many unsubstantiated claims of efficacy and disappointed customers who buy one herb, find it useless and never buy another while they tell their neighbor that they had a bad ex perience, and then their e have indeed lost a hero in the cause of herbal medicine. W Now we need to continue his work and manifest his dream of bringing high quality herbal medicines into the forefront of our conventional medical system. I am ready! Stephanie Maxine Ross, M.A., M.H., H.T. Medical Botanist Faculty, MCP Hahnemann University College of Nursing and Health Professions, C.E. (former Course Director of Botanical Medicine, Temple University School of Medicine) neighbor does n't buy one either. I think that the system of dietary supplement regulation is totally unfair to the consumer. There is no quali ty ass urance, the bewildered consumer can't tell the good from the bad, only structure-function claims are allowed, and these are often so ambiguous that the customer does not understand what the herb is to be used for. It permits ineffective products to be marketed, often with outrageous claims for effi cacy; and it con trasts with the German system that permits quali ty, well-tes ted products to be marketed (i n the case of Germ any) as medicines. I think - and I'm basically an optimist - that the herbal fi eld will successfully pass this crossroads. Bur I think that will rake Photo © 1994 Charl otte de Frances Chinese Drug Monographs and Analysis Edited by H. Wagner, R. Bauer, Xiao Peigen, and Chen Jianming Four new monographs include pharmacopeias found in, first cited in, official drugs, description of drug, pretreatment of raw drug, medicinal use, main constituents, pharmacology, TLC fingerprint analysis and discussion, and HPLC fingerprint analysis and discussion. • Radix Angelicae sinensis (Danggui) Chinese Angelica #424P • Radix Angelicae dahuricae (Baizhi) Fragrant Angelica #424Q • Radix Ligustici chuanxiong (Chuanxiong) Szechuan Lovage #424R • Pericarpium zanthoxyli (Huajiao) Prickly Ash Peel #424S $}2 each All 17 monographs $}80 (Save over 10%) #424! (For a complete listing of monographs, visit ABC's website www.herbalgram.org, or call 1-800-373-7105 ext. 111) To order, call toll free 800/373-7105, fax 512/926-2345, email: [email protected] or order online at www.herbalgram.org 60 Herba!Gram 54 2002 place o nly when some of these deficiencies, which I have spoken 8. Lawson LD. Effect of garlic on serum lipids [letter]. JAMA about, can be remedied. I have presented one solutio n; I would 1998;280( 18) 1568. certainly be amenable to listening to others, and there may be oth 9. Norton SA. Raw animal tissues and dietary supplements [lerrer]. N Eng!] Med2000 Jul 27;343(4):304-5. ers that are equal ly o r even more viable. Bur I think we have to I 0. Melcharr D, Walther E, Linde K, Brandemaier R, Lersch C. Echi remedy the deficiencies that exist in our present system. The over nacea root extracts for rhe prevenrion of upper respiratory traer infec al l objective should be to integrate herbs into the existing medical tions. Arch Fam Med 1998;7:541-5. system. That way they becom e nor alternative, not complementa II. Garges H , Varia I, Doraiswamy P. Cardiac complications and deliri ry, bur integrated medicine. I think that's the goal that we should um associated with va lerian root withdrawal [letter]. }AMA seek, because if we do, and if we attain that status, many benefits 1998;280: 11566-7. will result. There will be cost savings because these items will be 12. U.S. Food and Drug Administration, Cenrer for Drug Evaluation reimbursed by insurance companies, and they wi ll cost less than and Research (COER). Guidance for Industry: Botanical Drug the synthetic drugs that insurance companies currently cover; there Products. (Draft Guidance). Aug 3, 2000. 13. Bayne HM. FDA Publishes New Draft Guidance for Botanical Drug will be fewer adverse events because herbs, in general, are mild Products. HerbaLGram 2000;50:68-9. with mild side effects; and there will be better health care for all Americans. -"' References * Editor's Note: In this paragraph, Prof. Tyler is referring to five sepa I. Blumenthal M. Herb sales down 15% in mainstream market. rate chemical studies on herbs conducted over a period of rime (the Herba!Gram 2001;51:69. yohimbe study was published in 1995 and may nor be reflective of 2. W ilt TJ, lshani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw yo himbe products currently on rhe U.S. marker [Berz JM, White palmetto extracts for rrearmenr of benign prostatic hyperplasia: a sys KD, Der Marderosian A. Gas chromatographic determination of tematic review. }AMA 1998;280(18): 1604-9. yohimbine in commercial yohimbe products. j AOAC fnt 3. Koren G, Randor S, Marrin S, Danneman D. Maternal use of gin 1995;78(5): 1189-94.] In general, Prof. Tyler welcomed rhe increased seng and neonatal androgenication. }AMA 1990;264(22):2866. scrutiny of rhe quality of herbal supplemems by chemical analysis. 4. Awang DVC. Maternal use of ginseng and neonatal androgenication. However, he frequently expressed his concern about some popular JAMA 1991 a;265( 14):1828. reports claiming rhar various herbal products might be deficient in 5. Awang DVC. Maternal use of ginseng and neonatal androgenication. providing various active or marker compounds. He questioned the ]AMA 1991 b;266(3):363. validity of the laboratory analytical methods used in some popularly 6. Waller DP, Marrin AM, Farnsworrh NR, Awang DV. Lack of andro promoted rests and whether rhey were subjected to appropriate peer gen icity of Siberian ginseng [letter]. }AMA 1992 May review prior to publication, which many were nor. Neverrheless, 6;267( 17):2329. while recognizing that there are numerous high quality herbal prod 7. Berthold H, Sudhop T, von Bergmann K. Effect of a garlic oi l prepa ration on se rum lipoproteins and cholesterol metaboli sm: a ran ucts in rhe U.S. marker, he was deeply concerned about herb quali domised controlled trial. }AMA 1998;289(23): 1900-2. ty in general; his mention of rhese examples reflects this concern. • Diverse curriculum with more than 20 herbal mentors • Comprehensive one, two and three year programs in ~estern f1erbalism • Earth-centered herbal traditions • Recommended by leading herbalists • Colorado state certified More than 450 graduates shaping the future Call 303-442-6861 Rocky Mountain Center for Botanical Studies, 2639 Spruce St., Boulder, CO 80302 [email protected] www.herbschool.com 2002 Herba!Gram 54 61 ~ Legal & Regulatory Trade Organizations, Court and Government Actions Affect Herbal Industry by Mark Blumenthal continues to emphasize substamiarion of claims, just as it did prior to the passage of the act in 1994. AHPA Announces Self-Regulatory Policies on Herb Safety Labeling and Patient Disclosure of Herb Use However, John Taylor, Director of FDA's Office of Enforcement criticized perceived flaws in OSHEA: (l) that manufacturers are n October 2001 the American H erbal Products Association not required ro register with FDA, so that the agency finds it "dif (AHPA) rel eased new self-regulatory policies and positions I ficult to identify all of the so urces" of supplement products; (2) recently adopted by its board of trustees. First, AHPA adopted the that adverse event reporting is voluntary; (3) and that OSHEA's H ealthca re Provider Communication Policy, recommending that place ment of the burden of proof on FDA to substantiate its herbal supplement users inform their healthcare providers what actions in the removal of an unsafe dietary supplement ingredient supplemenrs they are taking. AHPA encourages healthcare "makes it much more challenging to bring enforcement action" providers of all disciplines to educate themselves on therapeutic against supplement companies. as pects of botanicals (both risks and benefits) in order to be more receptive to patients' alternative healthca re choices. Much of the hearing was focused on one particular company, Gero Vita International, ofToronto, and the claims that company Secondly, AHPA recommended that products containing herbs makes for its products. Two Gero Vita executives, reportedly listed in the organi zation's Botanical Saftty Handbook, under class 3 pleaded the Fifth Amendment in res ponse to some of the panel's (herbs whose safety requires that they be dispensed by a practition quesnons. er only), should carry "appropriate cautionary information on the label, including dosage, contraindications, potential adverse effects The GAO report ca n be downloaded at 62 HerbalGram 54 2002 Legal Regulatory Those wanring further information, or a copy of rhe Court's "75-day noti ce") and reminded AHPA rhar rh e marketing of a finding can conracr McGuffin ar AHPA via email ar 2002 HerbalGram 54 63 arke Report Consumer Attitudes Predict Upward Trends for the Herbal Marketplace by Maryellen Molyneaux channel stores, they are increasingly channel increase dropped to 26%. This dramatic switching (i .e., shopping for herbal prod drop in "increased usage" of supplement lthough the herbal supplement indus ucts at mainstream outlets as products and products from year to year clearly indicates try has experienced severe downward A brands become more widely available, often that issues of belief in importance, under trends over the past two years, market indi at lower prices). standing of usage, dosage, and benefits, as cations look good for the near future. The well as perceptions of overall quality, are Natural Marketing Institute's (NMI) As an overall group, herbal supplements impacting product usage. Health and Wei/ness Trends Report (HWTR), users tend to be older (almost 60% over 45 an annual, nationally projectable survey of years of age and in older lifestages) , and well The good news is that increased herbal more than 2,000 households, showed fluc educated (a significant number have post supplement usage patterns and their impor tuating household usage levels over the past graduate degrees). More than 42% live in tance to maintain a healthy lifestyle are sta three years. Consumer usage of herbal sup large cities (defined as having populations ble or rising for 2001, again predicting an plements dropped drastically (-12%) during over 2 million), and they have slightly high upturn. For example, the HWTR showed the 12-month period of mid-1999 through er income levels than the general popula in 2000 that the importance of taking mid-2000, but over the past year that usage tion, a fact most likely driven by their edu herbal supplements to maintain a healthy is now trending upwards (+3%). Consumer cation levels. Their reasons for maintaining a lifestyle dropped from 16% in 1999 to confidence and attitudes towards herbal healthy lifestyle are rooted first in preven 14%. However, consumer confidence is supplements are also on the rise, indicating tion, fo ll owed by enhancement, and treat trending upwards in 2001 and the impor more positive sales growth opportunities for ment. This relates to the overall health ben tance of taking herbal supplements is up to 2002 and beyond. efits they seek from herbal supplements. 17%, a good predictor for positive growth They are self-care seekers: 65% more likely in year 2002 herbal sales. The HWTR revealed several reaso ns for than the general population to use alterna decline in market penetration and soft sales The influence level of all "media" sources tive healthcare services and 18% more likely evident over the past two years: decreased of information has declined during the past to use over-the-counter (OTC) medications. consumer confidence, and decreased con two years. For example, the percentage of However, while 37% of shoppers indicated sumer beliefof the importance of taking sup general population co nsumers who indicate herbal supplement use over the past year, plements. Consumers also related that dur that magazines have "a lot/little" influence only 16% use herbal supplements regularly ing this same period, the media had less on the purchase decision declined from (i.e., on a daily basis) . Therein lies a signifi influence on their purchases as result of 75% in 1999 to 61% in 2000. However, cant inconsistent or lapsed user consumer conflicting messages. Not to say the media this is not to say that magazines don't have base, with an obvious opportunity to double had no influence; in reality it had a negative significant impact. In fact, 85% of herbal sales by increasing usage. Increasing usage or effect. Conflicting media messages deflated supplement users list reading as a lifestyle or attracting new herbal product users will hap consumer confidence, increased their con hobby activity, compared to 79% of the pen only as manufacturers respond to con fusion, and reduced understanding of general population. In one-on-one inter sumers' need to understand such aspects as herbal benefits, which led to a decline in views, consumers relate feelings of confu dosage, quality, and efficacy. Manufacturers attitudes towards herbs and health, and ulti sion over conflicting messages. From con must also improve brand building by mately, reduced usage. sumer interviews, it can be hypothesized becoming more consumer oriented. The size of the total herbal supplement market was $4.1 billion in 2000, according Table I Herbal Supplement Users, Summary Demographics to NMI, with 35% of those sales occurring in health and natural food stores, and 33% Age 60% are 46 and older of sales in food, drug, and mass outlets. The Education Tendency towards college-educated and graduate degrees balance of sales is via direct sources such as 55% are older lifestages (single, retired couples, parents) multi-level marketing, practitioners, mail Life stage order, and the Internet. In the year 2000, Household Size 60% live in I or 2 person households 37% of all households reported using City Size 42% live in cities with more than 2 million population herbal supplements, while 64% of natural Income Tend to have sl ightly higher incomes than general population channel shoppers indicated the same. Self care seekers of personal health solutions The HWTR survey also captured changes that the quality of the message is driven by drive this higher penetration of herbal users in specific product usage patterns. Of all editorial and advertising. Is the message within the natural channel. They are the herbal supplement users in 1999, 49% indi believable? Is it presented with consistently market for more than one-third of all herbal cated they had increased their usage during high standards? Does the accompanying supplement sales. They also set trends and that year; in 2000 only 28% increased con advertising relay a quality message? Analysis drive increased mainstream activity within sumption of herbal products. Likewise, in by specific consumer groups can actually herbal supplements. While they may seek 1999, 44% of all vitamin users indicated show that magazines play a significant role information and first purchase from natural increased usage in that year; in 2000 this in converting new consumers to core, 64 HerbalGram 54 2002 Report brand-loyal consumers. For consumers it is Lack of benefits delivered , both immedi rant to purchase agai n. Therefore, quality is a function of meeting their long-term needs ate and long term, is rh e most frequent rea viral to establishing both product trial and with believable information. son given by consumers for discontinued repeat purchase . Shoppers state that the reasons they first use, while lack of value or high price, credi As some of the previous information has started using herbal supplements were pri bility and safety iss ues are lesser iss ues. indicated, consumers remained co nfused marily for overall health and wellness Overall , 89% of all herbal supplement users about some herbal supplements. Recent (58%), followed closely by performance are not concerned about the saftty of these results of a H arris Interactive study' for the and energy, specifi c treatment, and preven products, but they are concerned about Dietary Supplement Informati on Bureau tion. Herbal products must deliver this product efficacy. While only 22% agree (DSI B) indicated that while 95% of Anler ex pected overall health benefit, and market completely/somewhat that they've tried icans are satisfied with the supplements they ing efforts must address the benefits that lie herbal supplements and found they were take, a fairly high number of consumers beyo nd consuming specific herbs. The not effective, another 52% are not sure they (2 I % to 58%) did not understand the ben ques tion could also be raised, " Do con derived any benefit from using herbal prod efits, and 29% were nor always adhering to sumers understand the benefits of specific ucts. W ith more than half of the use r pop recommended dosages. T he DSIB web herbs such as Sr. John's wort or echinacea?" ulation sitting on the fen ce about efficacy, sire, 2002 HerbalGrarn 54 65 Conference Traditional Knowledge Summit Builds Bridges of Intercultural Understanding for Ethnoscience, Conservation, Sustainable Development, Medicinal Plant Research, and Cultural Survival by Kim West respectively, involved direct social action for Mark Blumenthal, Founder and Executive the conservation of traditio nal cultures, lan Director, American Botanical Council; and he Building Bridges wirh Traditional guages, and environmental knowledge. '·' In Michael Balick, Ph.D., Director of Phile Knowledge II , An lnrernarional Sum T addition, research by National Tropical cology C urator, Institute of Economic mit Meeting on Iss ues Involving Indigenous Botanical Gard en Director, Paul Cox, Barany, New York Botanical Garden. Peoples, Conservation, Sustainable Devel Ph .D., in corporated ethnotaxo nomy in an opment and Er hnoscience, was held May Integrated Healthcare System: effort to ensure the survival of traditional 28-June l , 2001 , in Honolulu, H awa ii . Meeting Global Health Care Needs in Samoan culture.' T he Summit stressed thar Hosted and organi zed by Will McClatchey, the 21st Century scientific research into medicinal plants, Ph.D., Assistant Professor of Botany, and Nat Quansah, Ambodisakoana Clinic, Sov environmental reso urce manage ment, and orher fac ul ry, srudenrs, and friends of rhe inasoandro, Madagascar, and Herfyne Rami sustainable development depends upon rhe Univers iry of H awaii ar Manoa, rhis fi ve hantaniarivo, HIS University Training Hos survival of traditional cultures, language, day event was held jointly wirh the 42nd pital, Antananarivo, Madagascar and knowledge from which to lea rn . annual meeting of the Society for Econo m Nat Quansah, Ph.D ., disc ussed issues ic Botany and the International Sociery for involved with rhe lack of intercultural Ethnopharmacology. understanding in modern health policies. The first Building Bridges Conference, According to Quansah, these policies held in Gainesville, Florida in 1997, was encourage rhe adoption of Wes tern medi organized by a group of University of Flori cine, while neglecting traditional indige da graduate students frusrrared wirh rh e nous medical sys tems. As relatively expen lack of understanding and coll aboration sive Western pharmaceuticals and medical between scientists, conservationists, and services replace traditional systems, rather cultural represe ntatives . The success of rhat than adapting to rh em, many communities first meeting encouraged rh e organi za ti on are lefr wirh no healthcare options. This of rhe second conference. trend has also conrribured to a loss of The 200 l Summit included concurrent respect for traditional medical knowledge, morning sessions, regional plenary sessions, resulting in a loss of biological and cui rur- al diversiry. discuss ion groups, distinguished speakers, Traditional H awaiian culture was another displays and posters. Attended by more main topic at rhe Summit. Daily sessions On rhe orher hand, healrh care systems rhan 1,200 educa tors, students, scientists, were devoted to traditional H awa ii an health rhat integrate traditional medicinal plants conse rvationi sts, and cultural representa and culture, including chants, hula dance, and practices bridge rhe gap between tradi tives from around the world, rhe Summit music, science, and healing. T hese sessions tional and Western medicine, and present provided a forum to discuss intell ectual provided insight into the ways in which dif an appropriate solution capable of meeting properry ri ghts, natural resource use, and ferent cultures understand and interact wirh many global healthcare needs. This Inte orher iss ues affecring intercultural under rh e world around them. It is th is in valuable grated Healrhcare System is supported by standing between traditional cultures and traditional knowledge rhat should continue what Quansah call s rhe "pillars ofhealthcare ethnoscience. Presentation themes includ ro be preserved and shared between cul se rvice: " affordabiliry, availabiliry, effective ed: economic botany and ethnobotany, sus tures. ness, and efficiency. This sys tem targets tainable agri culture and business develop people's links wirh biodiversiry in order to W irh so many speakers, the o nly disap ment, ethnopharmacology and traditional meer health, economic, biological, environ pointment was the inabili ry ro attend all knowledge, education, and environmental mental and cultural diversiry conservation presentations. Following are sy nopses of a resource management. Srudenrs who partic needs. Wirhour rhese systems, Q uansah few presentations on traditional knowledge ipated in rhe Summit and attended a two said, "H ealth for all will remain a rhetoric and medicinal plant research. These repre week ethnobotany course that followed and not a reali ry." sent a small portion of rhe inspiring presen earned co ll ege credit. tations. Other key presenters and distin Quansah and Ramihantaniari vo prese nt The importance of conserving traditional guished speakers included Sir Ghillea n ed positive res ults of rh e Clinique de knowledge and cui rural diversiry was woven Prance, Former Director, Royal Botanical Manongarivo, a pilot rural health center in through all of rhe presentations. Many pre Gardens, Kew; Paul Ka' ikena Pearsall, Psy Ambodisakoana in northwest Madagascar senters, including Gary Marrin, Ph.D., and choneuroi mmunologisr/ Aurhor; Isa bella A. thar practices the Integrated Healthcare Sys Timothy Johns, Ph.D., mentioned rhar Abbott, Ph.D., Professo r Emeritus of tem approach,4 in which patients are exam their research in Morocco and Canada, Botany, Universiry of H awaii at Manoa; ined by borh a conve ntional Western-sryle 66 HerbalGram 54 2002 Conference physician and a traditional healer simulta rooms. In general, these plants share many neously. In this clinic, medicin al pl ants are common characteristics as used in tradi the preferred ueatmem, and convemional tional societies. Many promote intimation pharmaceutica ls are used only when herb of the divine or "other," are culturall y based medi cine is nor available. In addition, defined in small geograph ic areas, and are herbal medici nes are prepared in front of see n as "agents of god ," delivered by divine patients, so rh ey will learn how ro make interve ntion. rhem. T he clinic lab tracks what ailmem s Kilham also discussed plams' methods of are successfull y treated with medicinal adaptation and the theory that pl am s were plants. not domesticated/discovered by humans, The use of medicinal plants in the u eat bur conversely may have bee n using ment of cerrain diseases at the Ambodis humans to their benefit. This theory akoana clinic has helped the Malagasy peo explains rhar in some way plam s "know" ple ro understand rhe imporrance of saving what characteri stics ro have in order to be these plants. Many are being cultivated in protected and pro pagated by humans. Students Erin Foley (left) and Eiko Sae kr use ethnob otanical freld methods they learned durrng the Sum rhe clinic's medicinal garden ro ensure they According ro Kilham , with rhis adaptive mit courses to conduct a market survey rn Honolu won't disa ppear if destroyed in rhe wi ld . In scheme, psychoactive plants are somehow lu's Chrnatown. Photo ©200 I by Will McClatchey 2000, Quansah received the Goldman aware of the fact that if they can alter Environmental Prize, rhe world's largest human consciousness, humans will defend Ethnopharmacology or Bioprospecting: prize program honoring grassroots environ them and keep them close at hand. This Two Sides of the Same (Western) Coin? mentalists, for his work wirh rh e Ambodis id ea is also interes ting when applied ro Michael Heinrich, Centre for Pharmacognosy akoana clinic. '·6 medicinal plants in ge neral, and how well and Phytotherapy, School of Pharmacy, Uni people care for the plants that they value. Nights of Kava: versity of London, England Social Custom in Vanuatu In presenting the imporrant aspects of Michael Heinrich, Ph.D., discussed rhe cultivation, preparation, and ceremonial Chris Ki!ham, Medicine Hunter Inc., Lin characteri stics of ethnopharmacology and consumption, Kilham revealed the cultural coln, Massachusetts that altho ugh it is often reduced ro an aux importance of kava (Piper methysticum G. In a morning sess ion called Plants of the ili ary science in drug development - and Forst. , Piperaceae) in the archipelago of Gods, autho r C hris Kilham discussed many even equated with bioprospecting - Vanuatu. With more than 70 va ri eti es in aspects of psychoactive plams and rhe co n ethnopharmacology is a multidisciplinary Vanuatu, kava culture is well developed. nection between health and altered con science." Ethnopharmacology and bio Kava is traditionall y consumed as parr of a sciousness. The presentation began wirh a prospecting differ in many aspects, includ ritual group activity in ceremonial nacamal brief overview of psychoactive plants, which ing goals, characteristi cs, and key problems drinking huts, where beverage preparati o n range from coffee ro psychotropic mush- rhar rhey face. Erhnopharmacology entail s is parr of the ritual. In fact, much pride is understanding medicinal plam s, complex taken in every as pect of the kava exrracrs, and their uses in relation ro local ritual, from cultiva ti on ro con cultures. Bioprospecting involves drug dis sumption. covery and development of natural prod Seen as an antidote ro stress in ucts for the international market. the Wes t, kava is most ex tensively Ethnopharmacology is characterized by cultiva ted and consumed in a gathering detail ed information on a small place where this Western notion of segment of local flora and their local uses. "stress" does not ex ist. In Vanuatu, Bioprospecting methods are often narrowed this plant is an agent of peace, to compiling plant invenrories. While tranquility, kinship, and affilia erhnopharmacology deals wirh issues con tion. This ca n be seen in the spac cerning the safety and effi cacy of herbal ing between drinks of kava in rhe preparations, the key problems faced by nacamals, where participants bioprospecrin g involve the rights and agen patiently take turns in a rotation. das of local traditional cultures and com Summit Co-Coonnator Will McClatchey poses with ethnob By unde rstanding the cultural pensati on for access ro their intell ectual otany students who attended the conference and course that importance of kava in Vanuatu, pro perty. Hei nrich also noted rhe rol e of followed. (Front row. left to right) Shalli Ellis. Beret Halverson. one can begin to grasp the ways in Mahana Anderson-Wong. Puanani Anderson-Wong. Mike Foulk; erhnopharmacology in documenting plant which different cultures value their (second row) Catherine Davenport, Jennings Woods. Chnsty us age in o rd er to sort our rhe rox icological natural resources. Since 1995, Kil Butts. Eiko Saeki, Michael Wysong. Chantal Dessureau; (th1rd ri sks of medici nal plants. row) Dr. Sterling Keeley. Fred Jackson. Nancy Washburn, Kim ham has been conducting research West. Krisa Fredrickson, Erin Foley. Jodi Stevens, Han Lau, Robert in Vanuatu on kava, both the plant H einrich stressed rhe need for erhnophar Matsumoto, Ben Feinstein; (back row) Will McClatchey. Nathan and the tranquility-promoting macology to refo cus on irs anthropological Nishimura. Bruce Hoffman, Koa Shultz. Or·lo Steele. Kamaui beverage prepared from irs roots. - dimension and play a larger rol e ro develop Aiona. Nat Bletter. Jon Cohen. Photo ©200 I by Will McClatchey 2002 HerbaiGram 54 67 Conference local a nd indigenous pharmacopeias Again, this study illustrates the need for ("ethnopharmocopeias") .'' 12 He discussed conservation of cultural diversity and tradi some examples of ethnopharmacological tional medicinal plant knowledge, as well as research as it had been conducted during the need for intercultural understanding. the last two centuries, looking at the current Without acknowledgement of how medici role of this discipline in drug discovery nal plant knowledge and use differs from (especiall y with respect to the U .S. and culture to culture, one cannot successfully European markets). In addition, he exam understand the relationship between ined the further development of these phy humans and their environments. _. totherapeutical resources for local use in the A prospectus is currently being developed for countries of origin (ethnopharmacology). a third Building Bridges with Traditional Examples from 19th century research on Knowledge Summit. Organizers hope that it curare, the brew made from South Ameri will take place in Africa in order to balance can vines and other plants as arrow tip po i the meetings that have been held in the sons, from the 20th century on hallucino Caribbean (BBTKJ) and the Pacific genic mushrooms, and on Mexican Indian (BBTK2). Potential hosts, financial sponsors, indigenous plants illustrate the develop and other interested parties should contact ment of this discipline and highlight future Will M cClatchey at 68 Herba!Grarn 54 2002 New Items In ABC's Herbal Education Catalog Botanical Dietary Supplements: Quality, Safety and The One Earth Herbal Sourcebook: Everything You THE ONE EARTH Efficacy by Gail Mahady, Harry Fong, and Norman HERBAL SOURCEBOOK Need to Know About Chinese, Western, and I\111"T>II"" "-II 'Ilnnr • .,.,..._"l Farnsworth. 200 I. Based on a systematic review of rhe '"""-"·•un...... ,., .., ~*' ...... ,._,fWl.'l·" Ayurvedic Herbal Treatments by Alan Keith T ill ot scientific literature from 1975-2000 on some of the son, Nai-shing Tillotso n, and Robert Abel Jr. 2001. top-selling botanicals worldwide. 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Sofrcover, 596 pp. $20. Handboolc of Bey. 2002. Provides an easily accessed set of decision NATURAL #8511 M£DICIN£ making flowcharrs and summary in formation based on the best available evidence on natural medicine Psyche Delicacies: Coffee, Chocolate, Chiles, Kava, options, including herbs, supplements and dietary and Cannabis, and Why They're Good For You by advice. Covers 74 common diseases and includes sci Chris Kilham. 200 I . Passionate portraits of fi ve wide entifically verified therapies. Sofrcover, 522 pp. ly used psychoactive plants that have affected rhe $39.95. #8506 course of human history. Weaves history, folklore, and science into a case for rhe enthusiastic, guilt-free use of Dangerous Tastes: The Story of Spices by Andrew these plants. Presents clinical and academic evidence to Dalby. 2000. Highlights 60 spices in a historical explo show that these agents of nature, taken in moderation, ration of the spice trade drawn from ancient and are not harmful to us . 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Addresses regulation in the UK and EU, The Scientific and Technical Profile of the Genus safery issues, efficacy of herbal drugs, qualiry and stan Thymus by Wudeneh Lerchamo, PhD. 2001. Com dardization, synergy and more. Sofrcover, 120 pp. prehensive and authoritative review of history, botany, $39.95. #8509 taxonomy, chemistry, pharmacology, toxicology, genet ics, ecology, cultivation, harvesting, qualiry co ntrol, Medicinal Plants: Culture, Utilization and Phy processing and commerce of the rhyme species of the topharmacology by Thomas S.C. Li. 2000. Prese nts world. Summarizes data from over 700 references. data for more than 400 species in tables arranged in Sofrcover, 305 pp. $ 100. #85 15 alphabetical order by Larin binomial. Includes current information on major constituents and medicinal val Evidence-Based Herbal Medicine by Michael Rot ues, toxiciry or haza rds, essential oi l and their fractions, blatt, MD, and Irwin Ziment, MD. 2002. Analyzes a value-added products and their possible uses , cultiva large quanriry of the primary literature on controlled tion and harvesting, and infectious diseases and insects. clinical trials and provides reliable and practical infor Three appendices cross reference major active ingredi mation on the uses, pharmacology, efficacy, and ents and their sources, essential oils and their deriva adverse effects of approximately 65 herbal medicines tions, and the common and scientific names of the and a few non-herbal dietary supplements. Sofrcover, plants cited in the tables. Hardcover, 517 pp. $134.95. 464 pp. $29. #8516 #B510 To order, call toll free 800/373-7105, fax 512/926-2345, email [email protected] or order online at www.herbalgram.org ~A Book Reviews he Principles and Practice of Phy deeply involved in the maze of regul atory T he second part of the book, address ing T totherapy: Modern Herbal Medicine iss ues surrounding phytorherapy and natu practical clinical iss ues, manifes ts the by Simon Mills and Kerry Bone. C hurchill ral products in Europe and Australi a. authors' mas tery of rh e fi eld. T he arcane Li vings tone, 2000. H ard cover, 643 pp. Who is the intended audience? In an ideal complexities of ideas concerning dosage are ISBN 0-443-0601 6-9 $75.00 ABC Catalog wo rld this is a text for new clinicians and sid es tepped by a clear, concise and usable # B44 1. phytotherapy students, whether purely chapter on dosage and dosage forms in W hat a pleas herbal, naturopathic, or orthodox. Howev herbal medicine. A section titled "A system PR. INCIPLES ure to read a er, the 20th ce ntury history of repression of ati c approach to herbal prescribing" AND book o n the herbal education in North Ameri ca makes addresses the chall enging iss ue of applying PR.ACTICE modern prac ti ce this volume an essential book fo r all herbal medicines in a holistic context. This or of herbal medi invo lved with herbal iss ues ro day. T his secti on shoul d be required reading for all cine, written by includes cl inicians, teachers, students, regu U .S. herbali sts. T heir approach is nor one of k nowled geable, lators, manufac turers, and journali sts. rote formulas, bur to identify and rhen ex peri enced cli The first part of the book explores what address individual needs for phys iological nicians of phy they call Background and Strategies. The enhancement or compensa ti on. T hus, the to therapy. Not authors have eloquently described a number importance of ra king case history and its the least pleasure of different systems of herbal medicin e fro m ca reful interpretati on is emphas ized. Gener of this book is their literate, erudite, ye t around the world and throughout history. al herb al approaches ro pathological stares eminently readable sryle. T he ri chness of T his brief review cannot ex plore the philo are explored, providing the rationale for the this essential volume refl ects the autho rs' so phical and therapeutic importance of the specifics rhar foll ow. The broad issues inves depth of cl inical, research, and didactic cre authors' ideas but the systems ex plored ti gated are feve r, infecti ous diseases, dentia ls. range from G raeco-Roman med icine, Tradi auto immune diseases, debili ry, and mali g The Principles and Practice ofPhytotherapy ti onal C hinese Medicin e, Ayurveda, and nant diseases. An interesting addition here represents the fi rst text in Engli sh to 19th century North American systems such is an exploration of ro pical herbal applica describe modern herbal medicine as it is as the Eclecti cs. All this is integrated into ti ons, their pharmacology, and indicati ons. actually practiced by well -trained practi identified common themes and even viewed The discuss ion of herbal approaches to tioners of this profound therapeutic modai from the perspecti ve of C haos theo ry. sys tem dysfunctions provides practical Iry. A useful review of phytochemistry and informatio n, blending clinical ex peri ence of It is a tim ely addition to the burgeoning herb al pharmacology follows, discuss ing the Wes tern herbali sm with insights from phar libra ry of books on medical herbalism primary groups of constituents and their macology in such a way as ro guide the aimed at hea lrhca re pro fess ionals. In fac t, I known activiti es. Howeve r, the authors are practitioner in individual protOcol develop would say it se ts new standards fo r dialog ca reful not tO overwhelm readers with ment. lr is refres hing to see such herbal clin between practitioners of va ri ous modalities, chemical derail s, noting that the activiry of ical guidelines presented in a sryle free from el ucidating di recti ons fo r educati on, boding herbs is rarely due to a specifi c molecul e, hype and rh e lates t "miracle herbs." The well for the professionali za ri on of phy bur to an intricate synergy of phytochemi materi al is free from dogma, emphas izing to therapy in the U.S. cal complexity. the strengths of phytotherapy while not glossing over the weaknesses. T he authors M ills and Bone have such impress ive cre Principles of herbal treatment are articu clearl y identi fy one of the unique strengths dentials in all as pects of phytorh erapy that la ted with the emphas is one would ex pect of phytotherapy as treating individual va ri this review could simply consist of a tour of from phytotherapis rs so well grounded in abili ry. They show how to support healthy their achi evements and contributions. The holi stic medicine. They provide cl ear functioning as well as fa cilitate recuperati on authors are both fell ows of Britain's Natio n acknowledgement that competent phy and repair. After reviewing ge neral health al Insti tute of Medical Herbalists (NIMH). ro rherapy is more than simply the use of iss ues for the system , a selecti on of patholo Simon Mi lls is the direcror of the Centre for herbs; their use in a well- ro unded, individ gies exemplify how to develop phytothera Complementary Health Studies at the U ni uali zed program must also rake in to peutic protocols. T hroughout this section, ve rsiry of Exeter, the secretary of the Euro account diet and li fesry le, etc. ca re is taken to ex press any cautions to be pean Scien tifi c Cooperative o n Phyrorhera A brief, but inva luable, secti on discusses taken into account, either due to the condi PY (ESCOP), a pas t pres ident of the the va lidati on of herbal therapeutics, N IM H , and a co-author of the British ex pl o res resea rch methodo logy, rh e ti on being treated or the herbs suggested. Herbal Pharmacopoeia. Ke rry Bone is the stre ngths and limitations of the research Part three consists of an in-depth materia principal of the Australian Coll ege of Phy paradigm, and looks at ways to assess herbal medica. H owever, if there is any criticism totherapy, and has a deep interes t in both effi cacy validly without compromising fun of this book, it is the relatively small num clinical and laborarory research. H e is the damental iss ues of herb integri ry. A discus ber of herbs disc ussed - o nl y 44. Each is head of resea rch and development at Medi sion of safery iss ues foll ows. Arguments prese nted in a well -structured, fully refer Herb, Australi a's largest manufac turer of co ncerning toxiciry and adve rse reacti ons enced way, blending traditio nal views with herbal med icines . His writings regularl y are explored fro m, both the perspecti ves of insights from phytochemistry, pharmacol appear in professional journals around the toxicology and the experi ence of actuall y ogy, and clinical studies. This pl ethora of Engli sh-s peaking world. Both have been using the plants. informatio n may be the reaso n why only 70 HerbalGram 54 2002 Book Reviews "~ 44 were chosen. Not all of the herbs used the bible of homegrowers, just as the earli European phytorherapy provides a rational in clinical phytotherapy have attracted the er editions have become the primary refer model for herbal medicine in the U.S., and attention of the research community. It ence for the fast-growing gourmet and such therapeutic categori es of herbs as adap must be remembered that a lack of medicinal mushroom busi ness sprouting togens, antioxidants, etc.). research does not mean a lack of effi cacy, up all over the U.S. T he second section (part 5), Commonly bur a lack of funding! Each entry d iscusses The book is replete wirh photos, some in Prescribed Herbal Medicines , contains the the name and irs synonyms, history and dramati c color, and line drawings showing therapeuti c information on the 20 herbs, parrs used, effects, traditional views about how to grow almost every conceivable edi blending traditional use data and modern the herb, its actions, primary clinical uses, ble fungus. The tome contains 25 chapters research and reflecting the author's fervent uses that might be extrapolated from any and six appendices, plus a glossary and fascination with the current clinical litera known pharmacology, dosage, prepara index. The information is comprehensive, if ture. Each herb monograph has a useful, tions, duration of use, and safety data. An not exhausti ve, but it is written at an acces brief rwo-page overview of the relevant clin invaluably extensive, well- constructed sible, understandable level that allows a ical data (part used, common/essential uses, index is included. beginner or experr to dive right in. Nothing active constituents, how it works, recom The Principles and Practice ofPh ytotherapy is taken for granted; one needn't be a mycol mended use, side effects, safety iss ues/ drug balances the respect and understanding of ogist to navigate through this book. The interactions. T his is followed by several science with the respect and experience of chapter on the Role of Mushrooms in pages or more of text with background tradition. It shows the authors' profound Nature should be read by everyone, whether information and botani cal data, some histo grasp of their subject through a we ll -bal they intend to grow mushrooms or nor. ry and modern development, discuss ion of anced blending of logical, controll ed, per Knowing the essential contributions fungi medically active constituents, how rh e herb spectives of pharmacology with the variable make to the cycles of life is imperative to the works from clinical pharmacology perspec realities of treatin g real people with real understanding of biology. Wirhour fungi , tive, and healrhcare appli cati o ns (o r, how to herbal medicine. Simon Mills and Kerry rh e enrire biologica l system coll apses. use the herb most effecti ve ly). All this data Bone are to be congratulated for this cut Andrew Wei! , M.D., writes on the back is referenced to the ci rations given by chap ting edge contribution to health care in the cover that this book is the "most compre ter in the back of the book, a formatting 2 1st century. hensive manual of mushroom culti vation technique used by the publi sher presumably -David Hoffmann, B.Sc. (Hons), FNIMH-"' ever - fill ed with readable, useful informa to create a "cleaner" read for the average consumer, but which is so mewhat bother rowing Gourmet and Medicinal tion about every known mushroom species so me for those of us who routinely copy Mushrooms. Third edition. by Paul rhat people es teem for food and fo r medi G these monographs for our fi les or who like Stamets. Ten Speed Press. 2000. 574pp., cine. Expanded, improved and destined to to fax them to journalists et al. ; it's some softcover, color/black and white photo be a class ic." Amen. times easy to leave out the refe rences. graphs/illustrations. ISBN 1-58008-175-4 -Mark Blumenthal -"' The las t section, Herbal Presc riptions for As fungi become more popular as both erbal Prescriptions for Health and Common Health Conditio ns, provides gourmet and health foods, as well as medi Healing. by Donald J. Brown. Prima H therapeutic options from the phytomedici cines, growing one's own mushrooms is Health, 2000. 442 pp., sofrcover. ISBN 0- nal data presented previously. This is divid becoming trendy and so meday may 7615-2410-X. $24.95 ABC Caralog #B467 ed by phys iological system (ca rdiovascul ar, become as popu Originally published in 1996 as Herbal digestive, etc.) and then further into various lar as vegetable Prescriptions for Better Health (and reviewed co nditions within each system (e.g., athero gardening. High in HerbalGram 37'), this new edition scleros is, angi na, congesti ve heart failure, ly covered closet includes rev isions of the earli er work, hypercholesteremia, and Raynaud's disease space, cell ars, including more recent references. Unlike within the cardiovascular section). Consis garages, and most consumer-orienred books on herbs, tent with the author's naturopathic training, other dark areas this book fo cuses on only 20 of the most these recommendations include non-herbal wi ll become popular herbs in the modalities as well : conventional dietary prime spots for U.S. market, which supplements and dietary recommendations. home-growin g also happen to be the Unfortunately, there are too many herbal areas of edible most well-researched books on the market wrirten by people with and medi cinal - not a coin cidental little or no ex peri ence with herbs and the fungi, poss ibly giving a whole new mea n correlation, as vari herbal literature (see Al Leung's critique of a ing to "fun guy." The pre-eminent fungal ous industry veterans much-promoted and heavil y fl awed mass fun guy is Paul Stamets, one of America's have pointed our. market book as an example, reviewed in the premier mycological masters, or as I prefer T he book is divided last iss ue of HerbalGram.)' Fortunately, the to call him, the frenetic fungal fanatic. He into three essential information in this book is accurate, has revised his highl y acclaimed Growing sections: the front authoritative, and reli able. Gourmet and Medicinal Mushrooms, proba matter with useful background information bly the largest, most extensive publication (e.g., how to choose the best herbal supple -Mark Blumenthal-"' of its kind. This book is destined to become ment, frequently asked questions, how I. Blumemhal M. Herbal Prescriptions for 2002 HerbalGram 54 7 1 ~A Book Reviews Berrer Hea lrh : Your Everyday Guide ro Pre erences in the pocket guide is not a signifi edieval Herbals: Illustrative Tradi vention, Trea rmenr, and Care [book cant problem. Another iss ue is the readabil M tions. by Minta Collins. The British rev iew] . Herba!Cram 1996;37:67. ity of the charts on drug interactions and Library and University of Toronto Press. 2. Leung A. T he Complete G uide ro Herbal cautions. The format makes it difficult to 2000. ISBN 0-7123-4638-4 (cloth) 07123- Medicines [book review]. Herba!Cram quickly access the inform ation. 200 I ;52:7 1-2 . 464 1-4 (paperback). Given the riri e, readers might expect a T his is a beautifully atural Dietary Supplements Pocket balanced number of botanicals and dietary MEDIEVAL,..,, __ ,,._HERBALS illustrated book Reference. Edited by Dennis ]. N supplements. Coenzyme Q lO is the o nly about som e of the McKenna, Kerry Hughes, Kenneth Jo nes. non-herbal dietary supplement included in rarest and m ost beau 2000. Institute for Natural Products the guide. A new editio n expected in tiful hand-printed Research. 96 pp., illustrated sofrcover, Spring 2002 omits Coenzym e Q!O, and books of h erbal lore ISBN: 0-9701467-0-1. $ 14.95 ABC Cata the title is to change, reflecting the focus on and usage ever writ log #B493 botanicals. ten. It offers a This conveniently sized tremendous wealth of C linicians w ill benefit from the section on guide, developed under the background informa special precautions. It provides relevant d ata watchful eye of Dennis non about the ancient herbals that were on any safety concerns or contraindications. McKenna, Ph.D., strives to hand-copied for many centuries in m o nas For example, the bilberry ( Vaccinium myr fill a space left vacant by teries and libraries throughout an cient tiffus L., Ericaceae) m onograph recom books roo large to carry rimes, the Middle Ages, and the early Ren m ends that persons with hemorrhagic dis into stores o r examination naissance periods. Most interesting are the orders (excessive bleeding) should use bit rooms, such as The Com stori es about the people who wrote the berry extract o nly under a phys ician's super pLete German Commission E herbals and those artists, copyists, and vision. The special precautions section o n Monographs. Overall , this guide, published sch olars that kept them alive through the black cohosh (Actaea racemosa L. , Ranuncu by the Institute for Natural Products ages. T he color and black and white repro laceae; syn, Cimicifoga racemosa (L.) Nurr.) Research (INPR), a non-profit educati o nal ductions of the various early manuscripts, recommends that physicians m eet with and sciemific o rganizati o n, is an excellent such as the great Dioscorides Herbal help their patients to review effectiveness at six quick reference. bring the text alive. month intervals. The clinical review section T he 34 monographs are beautifully illus concludes each monograph and provides an Collins has written a m eticulo usly trated and color-coded , making it easy-ro excellent overview of clinical studies, with researched and scholarly work. Highly rec use and visuall y interesting. Each two-page details on the studied indications. omm ended for herbalists and herb lovers monograph includes the plant name, pri everywhere who want to know mo re about mary applications, recommended dosage, It is quite a task to summari ze the best the traditions of western herbalism and and key active constituents. T he back sec information available on herbs. By accurate thoroughly enjoy the process. T his is nor a tion of the book provides substantial cover ly condensing the vast quantity of botanical casual read, however. Be prepared to follow age of quality and regulatory issues. It also information, Dr. McKenna and his col the author through centuries of derails contains a brief listing of relevant books, leagues have taken a bold step in the ri.ght about the lineages of the illustratio ns and periodicals, and web si res. direction. -Alicia Goldberg-A herbal writers. One problem with the guide is the lack of -Christopher Hobbs, L.Ac., A. H. G. _..- references. Although size constraints make it difficu lt, without the inclusion of refer LETTERS pare in rhis program. ences, it is hard to evaluate the scientific cal Continued .from page 77 The AHG places value on rhe inreg ri ry of rh e iber of the work. H owever, this pocket ref herbal community; rhus rhe whole of rhe com erence complements ano ther INPR book, efforts by any political body ro arrempr ro munity is always considered in decisions made Natural Dietary Supplements: A Desktop Ref enforce restrictive standards on rhe practice of wirh in rh e AH G. Mosr of our commirrees are open ro AH G members and non-members erence, which does rely upo n autho ritati ve herbal medi cine. Regarding Ms. C hi chon's co ncern rhar fin an alike. Like Ms. C hichon, rhose who are references from peer-reviewed jo urnals. If cial inreresrs be disclosed, rhe AHG ce rrificarion in vo lved in rh e AHG council and adm inistra the clinician has both books, the lack of ref- process is nor underwritten, finan ced, or other tive rea m have a dee p love for plants and believe wise supported by any vested inreresrs wirhin or in rhe individual 's ri ghr ro practice herbal med outsid e of rh e organization. Our financial icine and ro seek rhe herbalist of rheir choice. As Great Bargains records are accessible ro members. The AHG a member-driven organization wirh a consen ex isrs so lely on membership dues, proceeds sus-based council el ected by rhe membership, Check out the Special Savings section from our an nu al sy mposium, and symposi um rhe power of individual voices in shap in g rhe of our online catalog at sponsorships. W irh rh e exception of office man orga ni zation is grear. We hope rhar Ms. Chi 72 Herba!Grarn 54 2002 ...... ~; , •'1: Journal Reviews ~~ ournal of Ethnopharmacology "An cer activity of Opuntia ficus indica," (a com fro m time to time. Book reviews are fea interdisciplinary journal devoted to mo n cactus of wide distribution with tured in each iss ue as well. The journal J potential clinical applicati ons). The biolog content is, without doubt, o ne of the most mdige nous drugs" interes ting, dive rse, and releva nt ro First published in 1979, this journal's edi ical activity of other plants readily ava il able researchers, es peciall y those interested in torial statement and purpose has remained in North Ameri ca and Europe of interes t to indigenous use of medicin al plants of any CO nSIStent: clinicians were al so ex plored recently: "The antiinflammatory, analgesic and antipyretic international journal. "The journal of activity of Nigella sativa" (the seeds of a T he journal's website, 2002 HerbalGram 54 73 In Memoriam Inspired by this new knowledge, Jense n rook postgraduate work at the ational C hiropractic Coll ege in Chi cago. Upon returning to California, he bega n to study intensively the new subject of iridology, the study of the iris as a diag nosti c tool. Jense n gave his first seminar in Iridology and N utrition in 193 1 at the Naturopathic Associatio n Conve ntio n in M il waukee, W isconsin . From that ti me, he taught class es all ove r the world with more than 3,000 doctors attending. His ex tensive research in iridology and nuuition eventuall y ea rned Bernard Jensen him rh e riri e of "Father oflridology" in the Heber W. Youngken, Jr. U.S. His extensive book, The Science and 1908- 2001 Practice of fridology, Volume I was published 1919-2001 ernard Jense n, D.C., Ph.D ., a pioneer in 1952 and has bee n considered by many eber W. Yo ungken, Jr. , dean emeritus Bof the natural health fiel d for more th an the leading publica tion in the fi eld. H of the Coll ege of Pharmacy at the 60 years, passed away in his sleep at his Jense n traveled to more than 55 countries Unive rsity of Rhode Island (URI) in home in Escondido, Cali fo rn ia, on Febru and thro ughout the U .S. ro observe the Kingston passed away at his home in Peace ary 22, 200 I. He was 92 years old. An av id li fesry les of di ffe rent cul tures. He operated Dale, Rh ode Island, o n O ctober 22, 2001 , beli ever in nutrition as the greatest single three health sa nitariums, including the Hid at 82 years of age. therapy to be appli ed in the holistic healing den Vall ey H ealth Ranch in Esco ndido, H onored fo r his contributions to pharma arts, Jensen saw the importance in treating California, fo r more than 40 years, teaching ceutical ed ucati on and research, he was the whole patient, not just the disease. the principles of nutrition and natural heal elected as an Ameri can Pharmaceutical ]orga n Bernard Jense n was born in Stock ing. H e also authored and published more Associati o n Academy of Pharmaceutical ton, California, on March 25, 1908. His than 40 books on health and natural heal Science and Research Fe ll ow. H e served as father, Eugene, was a busy chiropractor and ing, including The Chemistry ofMan, Foods pres ident of the Ameri can Sociery of Phar his mother, Anna, died of tubercul osis at that Heal, and Food H ealing for Man. Hon macognosy fro m 1969-1970. He chaired or the age of 29 when Bernard was still a ored throughout the world for his lifelong se rved on committees for the Ameri can young boy. T hese events laid the ground dedicati on to promoting the principles of Association of Coll eges of Pharmacy and work fo r his future pursuits. natural health, Jense n received several th e Academy of Pharmaceutica l Sciences. In awards and ho norary degrees, incl uding th e Rhode Island, he se rved on the Governor's At the age of 18, he entered the Wes t D istinguished Botanist Award in 1980 for Coast C hiropracti c Coll ege in Oakland, justice Commiss ion, the Statewide H ealth his work promoting herbal medi cines, the Coordinating Council, the Rh ode Island California. After three-and-a- half years of Pax Mundi Award for World Peace in 1982, an ending sc hool during the day and work Cancer Control Board, and the Rhode and the Nati onal Nutritional Foods Associ Island Health Science Education Council. ing at a creamery at night, Jensen received ati on's Pres ident's Award in 1996. his diploma in 1929, becoming the youngest H e authored over 180 arti cles in pharma doctor in the state of Califo rnia. H e opened He is survived by his wife, M ari e, fo ur cology and in the chemistry of pharm aceu his first office in Oakl and, offering his sons, 20 grandchildren and numerous tical plants. His articles appeared in such patients co mplete devotion and long hours, great-grandchildren. His so n, Art Jense n, journals as The Herbalist and The journal of while fo rgetting his own personal needs. His will co ntinue to operate Bernard Jensen Natura! Products. H e also authored two health fail ed as a resul t of this, leading to Internati onal. Jense n's educational work textbooks, Organic Chemistry in Pharmacy, hemorrhaging of the lungs, whi ch brought will be continued by his pro tege, Ell en Tart, published by ] .B. Lippinco tt in 1949, and his many youthful acti vities to a stop. T his and by the thousa nds of healthcare practi Pharmacognosy, published by J.B. Lippin starred Jensen on his li fe long ques t fo r ti oners and students who drew inspirati on cott in 195 1 and reprinted in 1965. from his life and work . health. After visiting doctor after doctor and In 1956, D r. Yo ungken came to the Uni still nor being offered any remedy, fi nally a -Kim West, ABC .AI versiry of Rhode Island fro m the Uni ve rsiry Seventh- Day Adventist medical doctor pre [Dr. Bernard Jensen. NNFA Today. 200 I of Washington in Seattle and served as the se nted a program of natural health mainte April ; 15(4): 15. first dea n of the new Coll ege of Pharmacy. nance that emphas ized the re turn to pure, Bernard Jensen Passes at Age 92. Whole Foods. By the time he retired in 198 1, the co ll ege 2001 May: 14. natural and whole vegetarian foods. Fo llow had grown fro m nine fac ulty and 135 ing this program bro ught Jensen back to 74 HerbalGram 54 2002 n Memoriam macy education. He also served as the first during his career. He chaired national and pharmacology ar Yale University School of provost for health science affairs and as act inrernarional symposia and served o n Medicine in New H aven, Connecticut, and ing presidenr for academic affairs. He was a numerous advisory commirrees, including as adjunct professor of medicine at the Tufts founder of the URl Foundation and served the Pulmonary Vascular Disease Advisory University School of Medicine in Boston, on its board for 17 years. He was a visiting Committee of the National H eart, Lung Massachusetts. professor at the University of London in and Blood Instirure and rhe World Health Later in his career he brought his back 1970 and at rhe University of Cairo, Egypt, O rganization's Expert Commirree on Pri ground ro study herbal medications. His in 1977, 1979, 1981 , and 1985. mary Pulmonary H yperrensio n. He was inreresr in this gro up of drugs came well For his service to the university's pharma recently appointed to serve on a committee before their currenr popularity. In rhe Feb cy education, the URl Coll ege of Pharma of the Natio nal Academies Institute of ruary 200 I FASEB Newsletter, he poinred cy's medicinal plant garden was dedicated to Medicine. H e served as associate editor of to the need for rigorous scientific study of him in 1994 and the Omar-Youngken Dis Biochemical Pharmacology and as a member herbal medicines, and called for borh basic tinguished Chair in atural Product Chem on the editorial boards of several pharmaco scientists and cli nicians to define rhe phar istry honored him in 200 I. A newly redec logical journals. m acoki nerics, toxicology, merabol ism, orated dining room was named for him, A native of Scotland, Gillis earned his bioavail abli liry and to assess gene expres honoring his service as founder and chair of Ph.D. in pharmacology from the University sion in response to phytomedicines. In rhis rhe University C lub. ofGiasgow in 1957. He taught in Scotland guesr opinion (" Biomedical Science and He is survived by his wife, Daphne, rwo and Canada before coming to Yale Univer H erbal Medicine: A Reluctant bur eces sons, John Ronald Youngken, of New York sity in 1961 as an assistant professor in rhe sary Alliance"), he call ed for public funds C ity, and Richard C harles Youngken, of Department of Pharmacology. H e detoured to support examination of herbal safety and South Kingstown, and rwo granddaughters. briefly to head rhe Cardiovascular and efficacy. Autonomic Pharmacology section at the - LeAnne Hunt _.. G ill is is survived by his wife, Bonita; son, Squibb Institute before returning to Yale. Steven; daughter, Sharon and son-in-law, [In Memoriam. Quad Angles. 200 I W in He became a full professor of anesthesiolo rer;9(2):4.] Thomas J. Phillips; and rwo grandchildren. gy and pharmacology in 1973 and served as -LeAnne Hunt _... rhe director of research in rhe anesthesiolo gy department from 1979-1993. He taught [Pearr K. In Memoriam: arional Specialist in Pulmonary Vascular Disease C. Norman Gillis at Yale until 1997. Afterwards, he served as [Yale Press Release]. 2001 Aug 20.] professor emeri rus of anesthesiology and Hot New Searchable Database! HerbCiip™ Online More than 1500 critical reviews of important journal articles with regular C. Norman Gillis updates in this leading herbal medicine information database 1933-2001 :...':"S.:::: (53 ,._a ..______,...... ___ _... ___ .. _...... __ ·-·- Available to ABC members ar rhe Academic Norman G illis, Ph.D., a natio nally ___ _ . level and above - View samples and join ar recognized specialist in pulmo nary vas - :;:::,. fL--- C r- r- www. ~ lerhal<;r.tm.org cular disease and pharmacology, died at the ,.-- • -•- oo>e~o O _.,._..., age of 68 on August 16, 2001. Also available fo r internet and In herbal circles Gillis is best known for intranet content licensing- Provide his research o n the production of nirric your customers with valuable infor oxide by the ingestion of Asian ginseng mation and resources o n issues affect (Panax ginseng C.A. Mey., Arali aceae) and the subsequent vasodilatation that results ing research, marketing, and the from rhis. H e also formed rhe Herbal Med responsible use of medicinal plants. icine and Medicinal Plant !merest Group within rhe American Society of Pharmacol For more information call 800 ~ 373 ~ 7105 or email ogy and Experimental T herapeutics. Gillis 2002 HerbaiGram 54 75 Letters PULLING TOGETHER the lifeblood of our businesses, and our pur in HerbalGram 52. T hank you so much for tak here can be no peace until everyone has chases are the lifeblood of those srruggling to ing on the journal ofthe American Medical Asso make a living in remote pam of the world. ciation (JAMA) and for getting ABC to rake breakfast. T Inform yourself. Don't "buy blind." Demand some acnon. At this time of global turmoil, unprecedented to know more about your raw material sources: I spent 30 years in engineering research and numbers of us are asking what we can do to Are people paid a better-than-living wage? Are thought only engineers did poor research. Now help heal the planet. How can we turn our plants harvested sustainably? Are processing l am a naturopath and find that the medical sense of sorrow, outrage, and patriotism into and production practices fair, ethical, and envi establishment does even worse research. The productive action) How can we reach out to ronmentally benign? If they aren't, rethink the news media, who are generally unable to deci make this world a better place for all of its peo way you do business - your shadow is much pher the research, like to pick up rhe results and ple? At the most basic level, how can we help larger than you think. spread them as the gospel (how could JAMA be assure that everyone has breakfast? Tell us your story. We all have wonderful sto wrong?). Generally the research on medicinal Ever since irs inception in the early 1960s, the ries to tell of the good works wrought by our herbs is egregious. natural products movement has been a force for industry. These stories seem to have gone large Please continue your efforts to make universi positive change, driven by visionary people who ly untold as rhe industry struggled ro defend ties and medical researchers conduct responsi care deeply for the earth and its inhabitants. itself against the media's negativity. It's rime to ble, unbiased research so that we can be enlight T his movement dared to question the status spread the good news, about how we and oth ened rather than fed the desires of the pharma quo, and a new path of health and well being ers are working to make a difference. ceutical or special funding groups. emerged. The new industry born to support ir spawned countless high-quality, earth-friendly If you have specific ideas on how to help ... Steve Shober, N.D. products and practices, including fair trade, Please contact Maureen DeCoursey at (303) Waunakee, Wisconsin certification, and other concepts of sustainable 449-2265 ext. 215 or [email protected]. H ERBALIST CERTIFICATION? living. Today, once again, we are called upon to H ere are some areas in which help is particu am writing in response to the article in act as pioneers in the realms of business, poli larly needed: l HerbalGram 52, and information obtained tics, and spirit. Volunteer your skills. Do you have business, from the American Herbalists Guild (AHG) Introducing rhe new "breakfast club." scientific, production, or marketing skills that website, in particular the Responses on Educa So many among us have given of ourselves, can help entrepreneurs in rhe developing world tion and Certification to the White House shared our bounty, and opened our hearts to to succeed in the natural products business? Commission on CAM Policy and rhe statement rhe needs of others. The time has come to go Contact us about short- or long-term volunteer on AHG Certification and Legislative Issues. I one step further, to lead the way as the U.S. cre programs that can bring your knowledge to am not surprised that these issues are being dis ates new ways of doing business with our inter those who need it. cussed, however, I am disappointed that a national neighbors on this small planer. Partner with rural entrepreneurs. What aspir broader base of the herbal community was not How? As businesspeople in an increasingly ing natural product suppliers need most are approached to participate in these discussions global industry, every decision we make has far markets. Are you willing to enter into buying and certification considerations. reaching effects, like ripples in a pond. In rhe contracts with grower/harvester associations in First multiple questions arise: What is your purchasing decisio ns we make, we vote with the developing world? This is the single best definition of Western herbal medicine? How our wallets. Bur we also have the power to vore way to "put your money where your mouth is" are the various cultures in Western herbal med with our values - shared industry values rhar in supporting socially and environmentally icine represented in your organization (which build upon the pioneering spirit at rhe heart of responsible herb production. defined and developed this plan) as well as in the natural products movement. Send us a letter of intent indicating your your exam? Why is your focus of initial certifi Join us, please, as partners in this new break interest in purchasing sustainably produced cation so structured and focused on business fas t club. We aren't asking for money. We're ask botanicals. Include particular species of interest, ("the consumer") and politics (government reg ing for partnership. We're asking all who care to if you wish. These letters will form a database ulators and media) and thus board certification, reach out and make a difference in the lives of rhar will be used to match suppliers of sustain when the focus of certification should be rhe those less fortunate in simple but meaningful ably produced materials with forward-thinking minimum standards and focusing on people's ways. Real peace and security stem from pros buyers. safety and keeping herbalism free? How can you perity and well being for all. We can help by Let's plan to get together for breakfast at the see this as not exclusionary? Your own organiza being good neighbors-good corporate neigh next Natural Products Expo in Anaheim, CA in tion rejects 2 out of 3 - isn't this the next step? bors -and contributing in whatever ways we March 2002 and find out who "we" are. This This is clearly the first step at saying "you are can to rhe economic betterment of the growers will be a great opportunity for us to reconnect not good enough" and "we are the only ones and harvesters worldwide on whom our indus and brainstorm future strategies. We look for that know what is right." Are you comfortable try depends. ward to seeing you rhen. as herbalists, potentiall y starting a process simi If you agree with rhis message .. . In a spirit of hope, lar to the one that politically stifled herbalists at Pass ir on to industry friends and supporters, the turn of the century) You make it clear that and please ger in touch with any one of us list Rob McCaleb you are creating a rigid identity for the "skilled" ed below. We need to create a groundswell of President, Herb Research Foundation expert in herbal medicine. Since American allopathic medicine is now interest around this issue. Lasting peace and Loren lsraelsen focused on evidence-based medicine, how do world security are everyone's responsibility and Executive Director, you see your cl inical herbalist practicing - require practical, strategic acrion. Here are Utah Natural Products Alliance some things we can all do to start making a dif standardized herbal medicine? How can you Maureen DeCoursey, ference immediately: design an exam before you define scope of prac Director ofSustainable Development, Commit to buying susrainably. We can tice? Herb Research Foundation choose to buy from companies that care about There is a great deal of naivete in this herbal rhe environment and rhe fair treatment of rhose KUDO AND ENCOURAGEMENT community if it believes that certification does who produce the ingredients we use. The qual was impressed by your article, "ABC Press nor quickly become licensure. As a nurse prac ity and sustainabili ty of these ingredients are Release C larifies Sr. John's Wort Confusion" titioner in the stare of New Jersey, I am certified I as a nurse practitioner and licensed as a nurse. 76 HerbalGram 54 2002 Letters Bur I cannot practice in rhis srare legally as a faced in the late 19 rh and ea rl y 20rh ce nturies. quali ty control in the herbal manufac turing nurse practitioner unless I have this certifica The "regular" medical profess ion began building industry. O ur members include sel f- trained tion, jusr as I cannot practice in this srare as a powerful insrirurions, and did wage an active herbali sts, apprentice trained herbali sts, gradu nurse unless I have this license - the term may campaign against the "irregul ars." The "irregu ates of formal herbal training programs, nurses, be different, bur the result is the same. lars" largely failed to mount a positi ve res ponse, midwives, phys ician's ass istants, pharmacists, I am also wondering about the disclosure of and instead engaged in sectari an ri valry rhar was naturopathic phys icians, and medica l doctors. fin ancial interes ts by those involved in develop a major fa ctor in the ultimate decline in rhe Another primary goal is ro kee p herbali sm in g this process. If support is wa nted for this practi ce of botani ca l medicin e rhar fo llowed . We and herbali sts - as you say, "free" and ali ve. project and we are to believe it is knowl edge hope to avoid repeating history by uni ti ng prac W ithin th is contex t, we also wish to hel p meet based, ethicall y sound, ex perrly drive n, and titioners and serring appropriate standards from rh e needs of those wishi ng to practice herbal ism unbiased , let's be up front and honest every srep within (such as the joint AHG/BMA cerrifi ca in increas ingly publ ic venues such as hospitals of rhe way, starring with full disclosure. rion process) in a way that supporrs dive rsity of and cl inics, and who find themsel ves required My love of herbs has been based on a dee p practice in botanical medicine. to provide so me evidence of having achieved an belief in plant-based medicine fo cused on rh e Exams and certifications will be offered at a objecti ve level of competence in order to do so. health and well-being of the people, and the basic and an expert level. These exams will be We see rhis as also part of keeping herbali sm right to choose from among rhe incredible open to all practitioners of botanical medicine strong and making it more available to those in diversity of plants, rhus employing pl ant wis with appropriate science-based education. need of herbal care. It is for rhis population of dom. It is sad to think that rather than a simple Given the voluntary nature of the exam, we herbali sts rhat the exam and certifica tion are basic agree ment on rh e sa fe practice of herbal have difficulty seeing this process as ri gid . How being developed. medicine to encourage diversity, there is a ever, we are open to constructive involvement The foc us of the initial examinati on and cer movement to defin e rh e ri ght practice of"Wesr of anyone interes ted in hel ping develop the tification process developed around identifying ern" herbal medici ne and rhus structured plant process. core competencies in Western botani cal med i wisdom. It will be interes ting to see if the same Finall y, our effo rrs to dare have received cine. T he template for rhe exam and rhe study thing that happened to rhe AMA and ANA almost no fin ancial support, with most of the guide were based on the cumulati ve res ul ts of (i. e., low percentage of represe ntati on of their endeavor being supported by vo luntee r efforrs two extensive surveys of our profess ional mem peers despite claiming to speak fo r all ) also hap or donations fro m individ uals. We have bership as well as practiti oners outsid e of the pens to rh e Ameri can H erbalists G uild . received in-kind do nati ons from Thorne organiza tion. Taking this examination is nor, Patricia G. Chichon Research. We co ntinue to try ro locate do nors, and will not be, required to become an AHG herbalist, nurse practitioner bur only from rhose who are willing to help us profess ional member. The AHG recognizes that Lambertville, Nj achieve our goals wirhour co mpromising our there is no one way to practice herbal medicin e, BMA Response beliefs. If anything, we are at a major econom and in rhis rests our strength and future. It is ic disadvantage as a res ult. because of rh e belief in non-exclusivity rhar we e appreciate Ms. C hichon's response ro have nor established a scope of practi ce whi ch our discussion of the effo rrs of rh e Amer Eric Yarnell, ND, RH W by irs nature necessaril y defin es what an herbal ican Herbalists G uild (AHG) and Botani cal President, Botanical Medicine Academy ist can and cannot do, can and cannot rrea r. Medicine Academy (BMA) to develop a volun Kathy Abascal, BS, JD, herbalist Our goal is merely ro establish an internal, tary certification process for practitioners of Executive Director, Botanical optional standard of excell ence rh ar allows botanical medicine. Medicine Academy AH G professional members and certified mem We deeply respect and support traditional bers to be eas il y recognizable by the general herbalists. Our article emphasizes the impor AHG Response public as reli abl e practitioners. tance of these traditions, and our bylaws man he decision to initiate a certification pro In order ro preserve traditional learning mod dare that we support diversity in the way botan gram within the Ameri ca n H erbalists els for herbali sts, borh professional membership ical medicine is practiced. At the same rime, T Guild (AHG) has taken yea rs of deliberation and el igibili ty for certification are obtainabl e many practitioners want a certification process, and discuss ion. Indeed , it is still undergoing with apprenticeship training, self-study, and and prese nrly a number of groups are arrempt evolution and refinement as we seek a balance other no n-conve ntional models, as well as ing to ce rti fy mainstream healrhcare profess ion between es tablishing intern al standards of through conve ntional educational roures. We al s in botani cal medicine. We are concerned exce llence in botani cal medicine practi ce while acknowledge that there are limitati ons to any that this splintered approach will produce a honoring traditional, community herbalis m. examination and certification process, and we narrow examination and ce rtifica tion process Parr of this process of refin ement in vo lves open are looking cl osely at how gaps can be bridged that will pit practitioners against each other dialogue with members of the herbal commu and non-quantifiabl e as pec ts of herbal practice rather than bring them together. We feel our nity, both within the AHG and beyond. can be incorporated into an assess ment process. process is a mo re progress ive alternative because The AHG is builr on divers ity and inclusion it is based on the practi ce of herbal ism rather The AH G has a strong and deliberate poli cy as fundamental principles . A core goal of the than state res idency or profess ional ca tegory. of refusing to participate in any process rhat is AHG is to supporr rh e wellness of rhe herbal We intend to offer certification only to herbal exclusionary to herbali sts. This applies ro our communiry as a whole, as well as to encourage ists whose practi ces incorporate a substantial own certificati on as well as to licensing, the lat communication and networking among herbal amount of Wes tern science, bur certifica tion ter whi ch we stead fas tly refu se to support. Like ists. AHG does nor attempt ro defin e Western Ms. C hi chon, we share the concern that we not will be voluntary to avoid marginalizing other herbal medicine, instead recognizi ng that there repeat mi stakes of rh e past century, neither do types of practitioners . Our goal is to provide an is great and valuable dive rsity in a multitude of alternati ve to state licensing that could (a nd we wish to emulate a conventional med ical belief sys tems and philosophies. W ithin the likely would) seve rely limit the ability of tradi model. We are proceeding slowly and ca refull y, AHG, we have members representing numer tional herbalists. Our efforts are of interes t to tryi ng to be mindful of pitfalls, and incorporat ous traditions, from C herokee to British to consumers and governmental regul ators bur are ing rh e concerns of peopl e such as Ms. C hichon Wise Woman herbalism. We have practitioners nor based on their interes ts. as we proceed . The AHG does nor beli eve that who serve at grassroots community levels in one has to have a credential to be an excellent We also believe that a joint effort among community drug rehabilitation programs as herbali st, and the AHG will nor support any botanical practitioners can avoid the problems well as practitioners wo rking to help the FDA Co ntinues on page 72 or even destruction the "irregular" professions and other regulatory agencies ensure reasonable 2002 HerbaiGram 54 77 Calendar Visit ABC's website 78 Herba!Gram 54 2002 Calendar oranisr Fran<;ois Couplan, PhD, and medi ca l herbalist Patricia Kyrirsi Howell, April 19-20: Integrative Pain Medicine, New York, NY. A CM E course co AHG. Contact: BoranoLogos, PO Box W, Mountain C ity, GA 30562-091 7. sponsored by The Columbia University Coll ege of Phys icia ns & Surgeons, Ph: 706/746-5485. Email: In rhis deparrmenr of Herbal Cram, we lisr resources such as publicarions, organizations, seminars, and networking for our readers. A lisring in rhis secrion does nor consrirure any endorsement or approval by Herba/Cram, ABC, or irs Advisory Board. The Apprenticeship in Ecological Horticulture is 604/52 1-5822; website: 2002 HerbalGram 54 79 Classified Foundation. A benefit ar all levels of membership in 120-639-3465 80 HerbalGram 54 2002 Top Selling Books In ABC's Herbal Education Catalog August through October 2001 Herbal Medicine: Expanded Commission E Monographs Making Plant Medicine by Richo Cech. 2000. The Ed. by M. Blumenthal, A. Goldberg, and J. Brinckmann. medicine making section includes: drying and processing 2000. 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