HERB PROFILE Hops Humulus lupulus L. Family: Cannabaceae

INTRODUCTION as noted from observations of young women who reportedly often ops is a perennial vine growing vertically to 33 feet experienced early menstrual periods after harvesting the strobiles with dark green, heart-shaped leaves.l,2,3 The male and in hops fields. lB H female flowers grow on separate vines.l.3 Hops are the Traditionally hops were used for nervousness, insomnia, excit­ dried yellowish-green, cone-like female flowers or fruits (tech­ ability, ulcers, indigestion, and restlessness associated with tension nically referred to as strobiles).l.4 Originally native to Europe, headache.l3 Additional folk medicine uses include pain relief, Asia, and North America,5 several varieties of hops are now culti­ improved appetite, and as a tonic.9 A tea made of hops was vated in Germany, the United States, the British Isles, the Czech ingested for inflammation of the bladder.? Native American Republic, South America, and Australia.4,6 Although still wild tribes used hops for insomnia and pain.5,8 Hops are employed in in Europe and North America, commercial hops come exclu­ Ayurvedic (Indian) medicine for restlessness and in traditional sively from cultivated plants.1,7 The leaves, shoots, female flowers C hinese medicine for insomnia, stomach upset and cramping, (hops), and oil are the parts of the plant used commercially. 8 and lack of appetite.5 Clinical studies in China report promise for the treatment of tuberculosis, leprosy, acute bacterial dysen­ HISTORY AND CULTURAL SIGNIFICANCE tery, silicosis (respiratory condition caused by the inhalation The name hops is derived from the Anglo-Saxon word hoppan of silica dust), and asbestosis (respiratory condition caused by meaning to cl imb.5,9 The species name the prolonged inhalation of asbestos parti­ lupulus is Latin for small wolf, referring cles) .5.l0 Externally, it has been applied to to the plant's habit of "wolfing" or climb­ treat dandruff, ringworm, sores, ulcers, ing on other plants, as a wolf would climb skin injuries, acne, and to alleviate pain and on a sheep.2,9 The beer brewing indus­ itching.6,7 In aromatherapy, hops have been try accounts for 98% of the world use of used for skin care, breathing conditions, hops.1·3 Originally used as a preservative, nervousness, nerve pain, and stress-related hops were later additionally used to add a conditions.l4 bitter flavor to beer.10 The earliest record Hops are approved in various monographs of hopped beer is in 822 CE.3 The cultiva­ and pharmacopeias as a treatment fo r excit­ tion of hops spread in Europe during the ability, lack of appetite, mood disturbances Middle Ages because beer was served with (restlessness, anxiety), sleep d isturbances, every meaJ.3 sleeplessness, and tenseness.2,16,17,1 9 Hops have been used as a food and for flavoring food and as a perfume scent for MoDERN REsEARcH over 2500 years.11 Pliny the Elder (circa One laboratory study has demonsrrated 23-79 CE) mentions Romans eating young antimicrobial activity in hops and has hop shoots.9 The young spring shoots suggested that hops constituents may be are still eaten in Belgium, France, and useful in mourhwash.20 Several clinical England in the same ways that asparagus is trials have supported the efficacy of a eaten.2.12 The flowers are a natural source combination of hops with valerian root of food flavoring.2,l3 They have flavored (Valeriana officina/is L., Valerianaceae) for cereal, beverages, mineral waters, spices, sauces, tobacco, and improving sleep.2l,22,23,24,25 No published clinical studies to date alcoholic beverages other than beer.l0,11 ,14 Hops have been used have examined the effectiveness of hops alone for any traditional in perfume, especially the spicy or oriental types, lO,l4 to give body use. to dry hair, and in skin creams and lotions.l0,15 FUTURE O UTLOOK Medicinally, hops are mainly used as a sedative.! With other There is a fixed worldwide demand for hops, dependent on beer herbal sedatives, hops can be beneficial for sleeplessness and consumption, with variable supply, which results in shortages and nervousness.6,l6 Efficacy has long been established, but the exact surpluses in any given year. 26 World production of hops is cycli­ mechanism for sedation is still unknown.? Hops also contain cal and typically peaks every 7-10 years followed by several years antispasmodic, diuretic, calming, sleep promoting, hypnotic, and of surpluses and depressed market prices. A relatively consistent antimicrobial properties.4,8,10,16,17 supply of hops is assured by the fact that they are grown in numer­ The sedative constituents are believed to be in the aromatic oils, ous places for specific markets.26 HG hence the rationale behind the traditional use of "sleep" pillows -Gayle Engels and Joyce Juan made of hops.14 The aromatic oils may also have estrogenic effects

Continues on page 4 Phoro by Steven Foster. ©2006 stevenfosrer.com www.herbalgram.org 2006 HerbaiGram 71 I 1 I\Jv1ERIGAN BOTfoNICAL COUNCIL Media Sponsors

~ NewHoPe remedies· NaTuraL Mema A Divisilln ofPmton MdUt. 1114. tasteforlife HOPS advisory board Continued from page I Each issue of Herba/Gram is peer reviewed by members of our Advisory Board and other qualified experts before publication. REFERENCES I. Bruneton J, ed. Pharmacognosy, Cindy K. Angerhofer, PhD Edward M. Croom, Jr., PhD Phytochemistry, Medicinal Plants. 2nd ed. Director of Botanical Research, Aveda Institute, Adjunct Associate Professor of Pharmacognosy, Paris: Lavoisier; 1999. Minneapolis, Minnesota University of Mississippi, Oxford, Mississippi 2. Onstad D. Whole Foods Companion: A Guide for Adventurous Cooks, Curious Shop­ John Thor Arnason, PhD Wade Davis, PhD pers & Lovers ofNatural Foods. White River Professor of Biology, Department of Biology, Explorer-in-Residence, National Geographic Society, Junction, VT: Chelsea Green Publishing University of Ottawa, Ontario, Canada Washington, D.C. Company; 1996. Dennis V. C. Awang, PhD, FCIC Steven Dentali, PhD 3. Tucker AO, Debaggio T. The Big Book of MediPiant Natural Products Consulting Services, Vice President of Scientific and Technical Affairs, Herbs. Loveland, CO: Interweave Press; White Rock, B.C., Canada American Herbal Products Association, Silver Spring, 2000. Maryland Bruce Barrett, MD, PhD 4. British Herbal Pharmacopoeia. Dorset, UK: Assistant Professor of Family Medicine, Hardy Eshbaugh, PhD British Herbal Medicine Association; 1996. Unive rsity of Wi sconsin-Madison Medical School Professor of Botany & Assistant Curator, Willard 5. Blumenthal M, Goldberg A, Brinckmann J, Sherman Turrell Herbarium, Miami University, eds. Herbal Medicine: Expanded Commission Marilyn Barrett, PhD Oxford, Ohio E Monographs. Austin, TX: American Botani­ Pharmacognosy Consulting Service, cal Council; Newton, MA: Integrative Medi­ San Carlos, California Trish Flaster, MS ci ne Communications; 2000. Ezra Bejar, PhD Executive Director, Botanical Liaisons, LLC, Boulder, CO 6. Tyler VE, Foster S. TJler's Honest Herbal. 4th Director ofTechnical Sciences, Herbalife International, Joe Graedon, MS ed. Binghamton, NY: Haworth Herbal Press; Inc., Los Angeles, CA Author, syndicated columnist, radio host, 1999. Durham, North Carolina 7. Wicht! M, Bri nckmann J. Herbal Drugs and Bradley C. Bennett, PhD Phytopharmaceuticals. Stuttgart: Medpharm Associate Professor of Biology, Florida International Charlotte Gyllenhaal, PhD GmbH Scientific Publishers; 2004. Unive rsity, Miami Research Assistant Professor, College of Pharmacy, 8. Bown D. The Herb Society ofAmerica New John A. Beutler, PhD University of Illinois at Chicago; Research Program Encyclopedia of Herbs and Their Uses. London: Staff Scientist, Mo lecular Targets Development Manager, Block Center for Integrative Cancer Ca re, Dorling Kindersley Ltd.; 200 1. Program, National Cancer Institute Evanston, IL 9. Grieve M. A Modern Herbal. Vol. I. New Frederick, Maryland Mary Hardy, MD York: Dover Books; 1971. Director, Cedars-Sinai Integrative Medicine Medical I 0. Duke J, ed. Handbook ofMedicinal Herbs. Josef Brinckmann Group, Los Angeles, California Boca Raton, FL: CRC Press; 1985. VP of Research and Development, Traditional II. Arctander S. Perfume and Flavor Materials Medicinals, Inc., Sebastopol, CA Christopher Hobbs, LAc, AHG ofNatural Origin. Carol Stream, IL: Al lured Francis Brinker, ND Herbalist, botanist, licensed acupuncturist, Publishing Corporation; 1994. Clinical Ass istant Professor, Department of Medicines, Davis, California 12. Davidson A. The Oxford Companion to Food. Programin Integrative Medicine, Un iversity of Arizona, David Hoffmann BSc, FNIMH London: Oxford University Press; 1999. Tucson Medical Herbalist, Author, and Research Associate 13. Barnes J, Anderson L, Phillipson J, eds. Herbal Traditional Medicinals, Sebastopol, California Medicines: A Guide for Health Care Professio­ Donald J. Brown, NO nals. London: Pharmaceutical Press; 2002. Director, Natural Products Research Consultants, Maurice M.lwu, PhD 14. Lawless J. The 1//ustrated Encyclopedia of Seattle, Washington Bioresources Development and Conservation Essential Oils: The Complete Guide to the Program, Senior Research Associate at the Division of John H. Cardellina, PhD Use of Oils in Aromatherapy and Herbalism. Expert Chemist, Developmental Therapeutics Program, Experimental Therapeutics, Walter Reed Army Institute of Research, Washington, D.C. Dorset, UK: Element Books, Ltd; 1995. National Cancer Institute, Frederick, Maryland 15. D'Amelio FS. Botanicals: A Phytocosmetic Thomas J.S. Carlson, MS, MD Timothy Johns, PhD Desk Reference. Boca Raton, FL: CRC Press Professor, School of Dietetics and Human Nutrition; Associate Adjunct Professor, LLC; 1999. Centre for Indigenous People's Nutrition and the Department of Integrative Biology; Director, Center for 16. Blumenthal M, Busse WR, Goldberg A, Environment, McGill University, Montreal, Canada Health, Ecology, Biodiversity, & Ethnobiology; Gruenwald J, Hall T, Riggins CW, Risrer RS, Curator of Ethnobotany, University and Jepson Herbaria; Kenneth Jones eds. Klein S, Rister RS, trans. The Complete University of California, Be rkeley President and Medical Writer, Armana Research, Inc, German Commission E Monographs-Thera­ Halfmoon Bay, BC, Canada peutic Guide to Herbal Medicines. Austin, TX: Jean Carper American Botanical Council ; Boston: Inte­ Author and syndicated column ist, Washington, D.C. Edward Kennelly, PhD grative Medicine Communication; 1998. Jerry Cott, PhD Associate Professor and Chair, Department of Biological 17. Bradley P. British Herbal Compendium. Vol. Sciences, Lehman College, City University of New York, Pharmacologist, U.S. Food and Drug Administration, I. Dorset, UK: British Herbal Medicine Bronx, NY Centerfor Drug Evaluation and Research, Association; 1992. Rockville, Maryland lkhlas Khan, PhD 18. Mi lligan SR, Kalita JC, Heyerick A, et al. Associate Professor of Pharmacognosy, Assistant Identification of a potent phytoestrogen in Paul Alan Cox, PhD Director, National Center for Natural Products Research, hops (Humulus lupulus L.) and beer. J Clin Executive Director, Institute for Ethnomedicine University of Mississippi, Oxford, MS Endocrin Metab. 1999;83(6):2249-2252. Jackson, Wyoming 19. European Scientific Cooperative on Phyto­ Steven King, PhD Lyle E. Craker, PhD therapy. ESCOP Monographs. 2nd ed. New Vice President, PS Pharmaceuticals, Inc., Professor, Department of Plant and Soil Sciences, York: Thieme; 2003. South San Francisco, California Un iversity of Massachusetts, Amherst 20. Bhattacharya S, Virani S, Zavro M, Haas GJ. Inhibition of Streptococcus mutans and other oral Streptococci by hop (Humulus

4 I HerbaiGram 71 2006 www.herbalgram.org lupulus L.) constituents. Economic Botany 2003;57(1): 11 8-125. advisory board 21. Schellenberg R, Sauer S, Abourashed EA, Koetter U, Brattstrom A. The fixed combina­ (continued) tion of valerian and hops (Ze9 10 19) acts via a central adenosine mechanism. Planta Med. July 2004;70(7): 594-597. Richard Kingston, PharmD, CSPI John M. Riddle, PhD 22. Fussel A, Wolf A, Brattstriim. Effect of a President, Regulatory and Scientific Affairs, Safety Caii TM Professor of History, Department of History, fixed valerian-hop extract co mbination (Ze International Poison Center; Professor, Department of North Carolina State University, Ra leigh 9 10 19) on sleep polygraphy in patients wi rh Experimental and Clinical Pharmacology, College of Eloy Rodriguez, PhD non-organic insomnia: a pilor study. Eur J Pharmacy, University of Minnesota, Minneapolis, MN. Med Res. 2000;5:385-390. James Perkins Professor of Environmental Studies, 23. Vonderheid-Gurh B, Todorova A, Brattstriim Thomas l. Kurt, MD, MPH School of Agriculture & life Sciences, Cornell University, A, Dimpfel W. Pharmacodynamic effects of Clinical Professor, Department of Internal Medicine, Ithaca, New York University ofTexas Southwestern, Dallas, Texas valerian and hops extract combination (Ze Holly Shimizu 910 19) on the quantitative-topographical Roberta A. lee, MD Executive Director, US Botanic Garden, Washington, DC EEG in healthy volunteers. Eur J Med Res. Medical Director, Co-Director Integrative Medicine, Victor Sierpina, MD 2000;5: 139-144. Continuum Center for Health and Healing; Director of Associate Professor of Family Practice Medicine, 24. Rodenbeck A, Si men S, Cohrs S, et a! . Alter­ Medical Education and Integrative Fellowship, Beth University ofTexas Medical Branch, Galveston ations of the sleep stage structure as a feature Israel Medical Center, New York, NY of GABAergic effects of a valeri an-hop prepa­ James E. Simon, PhD Martha M. libster, PhD, RN, CNS ration in patients with psychophys iological Professor of New Use Agriculture, Director of the Center Associate Professor of Nursing, East Carolina University, insomnia. Somnologie. 1998;2:26-31. for New Use Agriculture and Natural Plant Products, Greenville, NC 25. Schmitz M. Jackel M. Comparative study for Rutgers University, New Brunswick, New Jersey assessing quality of life of patients wirh exog­ Tieraona low Dog, MD Beryl Simpson, PhD enous sleep disorders (temporary sleep onset Clinical Asst. Professor, Director of Botanical Studies, C. l.lundell Professor of Botany, Department of Botany, and sleep interruption disorders) treated with Program in Integrative Medicine, University of Arizona University ofTexas at Austin a hops-valerian preparation and a benzodiaz­ School of Medicine, Tucson, Arizona epine drug [in German]. Wien Med Wochen­ S. H. Sohmer, PhD Tom Mabry, PhD President and Director, Botanical Research Institute of schr. 1998; 148:291-298. Professor of Plant Biochemistry, Department of Botany, Texas, Fort Worth 26. Ministry of Agriculture and Forestry to University ofTexas at Austin Manatu Ahuwhenua, Ngaherehere New Barbara N. Timmermann, PhD Gail B. Mahady, PhD Zealand. International Market for Hops. Chairperson-Professor of Medicinal Chemistry, Research Assistant Professor, Department of Medical Ava il able at: http:/ /www.maf.govt.nz/ University of Kansas, lawrence, Kansas mafnet/ rural-nz/ profi tab ili cy-and-economics/ Chemistry & Pharmacognosy, College of Pharmacy, producer-boards/structure-of-hop-industry/ University of Illinois, Chicago Arthur 0. Tucker, PhD hopmb002.htm. Accessed August 31 , 2005. Research Professor of Agriculture and Natural Robin J. Maries, PhD Resources, Delaware State University, Dover Director of the Bureau of Research and Science, Natural Health Products Directorate, Health Products and Food Nancy Turner, PhD Branch, Health Canada, Ottawa Professor and Ethnobotanist, Environmental Studies board of trustees Program, University of Victoria, British Columbia, Dennis J. McKenna, PhD Canada Michael J. Balick, PhD Executive Director, Institute for Natural Products Director and Philecology Curator, New York Botanical Research; Senior lecturer, Center for Spirituality and Daniel T. Wagner, RPh, MBA, PharmD Garden, Bronx, New York Healing, University of Minnesota, Minneapolis Owner, Nutri-Farmacy, Wildwood, Pennsylvania Neil Blomquist Marc S. Micozzi, MD, PhD Andrew T. Weil, MD President, Sustainable Solutions Consulting Services Executive Director for Integrative Medicine, Author, Director ofthe Program in Integrative Sebastopol, California Thomas Jefferson University Hospital, Philadelphia, PA; Medicine and Associate Director of the Division of Peggy Brevoort Director, Policy Institute for Integrative Medicine, Social Perspectives in Medicine, College of Medicine, President, Brevoort, llC, Kapa 'au, Hawaii Washington, DC University of Arizona, Tucson Norman R. Farnsworth, PhD Daniel E. Moerman, PhD Bernd Wollschlaeger, MD Research Professor of Pharmacognosy, Senior University William E. Stirton Professor of Anthropology, Family practice physician; Clinical Assistant Professor Scholar, University of Illinois at Chicago University of Michigan/Dearborn of Medicine and Family Practice, University of Miami, School of Medicine, Florida Steven Foster William Obermeyer, PhD President, Steven Foster Group, Inc., Brixey, Missouri Vice President of Research and Technology, Jacqueline C. Wootton, MEd Consumerlab.com, Annapolis, Maryland President, Alternative Medicine Foundation, Inc. Fredi Kronenberg, PhD Director, HerbMed• HerbMedPro™, Potomac, MD Director, Rosenthal Center for Complementary and Samuel W. Page, PhD Alternative Medicine, Columbia University College of Scientist, International Programme on Chemical Safety, Physicians and Surgeons, New York World Health Organization, Geneva, Switzerland ad hoc advisor: Morris Shriftman Joseph E. Pizzorno, Jr., ND David M. Eisenberg, MD CEO, Mozart, Inc., San Rafael, California President Emeritus, Bastyr University, Seattle, Director, Osher Institute, Washington, and Editor, Integrative Medicine: A Division for Research and Education in Complementary James A. Duke, PhD (emeritus) Oinician's Journal Botanical Consultant, Economic Botanist (USDA, ret.), and Integrative Medical Therapies, Herbal Vineyard Inc. I Green Farmacy Garden, Fulton, Mark J. Plotkin, PhD Harvard Medical School, Boston, Massachusetts Maryland Author, Executive Director, Amazon Conservation Team, Arlington, Virginia Mark Blumenthal (ex officio) Founder and Executive Director www.herbalgram.org 2006 HerbaiGram 71 I 5 dear reader American Botanical Council Mark Blument hal New AER Bill for Supplements and OTC DRUGS Founder and Executive Director he maturation of the modern herb and dietary supplement (OS) movement is evidenced Wayne Silverman, PhD by the introduction in June of a bill in the United States Senate, the Dietary Supplement Chief Administrative Officer and Nonprescription Drug Consumer Protection Act (S . 3546). The new bill, if passed T Sean Barnes into law, would require manufacturers of OS and nonprescription (over-the-counter, OTC) Herba/Gram Art Director drugs to include contact information on their products' labels for consumers to use in reporting serious adverse events (AEs). Also, companies would be required to report all serious adverse event Courtney Cavaliere reports (AERs) to the Food and Drug Administration (FDA) within 15 days. Herba/Gram &Herba/EGram Assistant Editor The bill's terms also provide that any AERs submitted to the FDA would not be construed as an admission of liability that a company's prod­ Gayle Engels uct caused or contributed to the reported event. The bill also provides for Education Coordinator protection of the identity of individuals reporting adverse events. Michael Finney Support of the bill comes from both sides of the aisle and both sides Herba/Gram Managing Editor of the dietary supplement debate: Senators Orrin Hatch (R-UT), Tom Lori Glenn Harkin (0-IA), Dick Durbin (O-IL), Ted Kennedy (0-MA), and Mike HerbCiip Managing Editor Enzi (R-WY), Chairman of the Senate HELP committee. Cassandra Johnson It appears that most of the OS industry has lined up in support of the Herba/EGram Managing Editor bill, as has the Consumer Healthcare Products Association, the organi­ Mart in Manuel zation representing the OTC industry, as well as the Center for Science Graphic Designer in the Public Interest, a large consumer group that has historically taken adversarial positions against the OS industry. Nancy Moon Executive Assistant One key industry figure, Loren Israelsen, founder and executive director of the Utah-based United Natural Products Alliance and one of the primary architects of the Dietary Supple­ Ellyn Pol is ment Health and Education Act of 1994, summed up his group's position: "We believe dietary Receptionist/Administrative supplements are exceptionally safe products and that this legislation will in future years Assistant confirm this fact. We also recognize that should a safety problem arise, we as an industry have George Solis a responsibility to quickly identify and resolve such situations and to do so in cooperation with HerbCiip Production Assistant FDA in those cases where the adverse event is serious." He also noted that, "It will also be Nat hanael Sponseller incumbent on FDA to administer this legislation in such a way that all parties have full confi­ Gardener dence that the intent and spirit of this bill is fully respected, which is to work with industry to Cecel ia Thompson resolve serious adverse events reports, rare as they may be, quickly and judiciously." Finance Coordinator Past concerns voiced by critics of the OS industry were that the industry was being either irre­ Aileen Truax sponsible by not reporting serious AERs or it was perceived that the industry was not adequately Development/Marketing regulated by virtue of its not having to report AERs. The makers of OTC drugs have not had Coordinator such a requirement, so it was a good move politically, and a reasonable proposal, to include seri­ Margaret Wright ous AERs for OTC drugs in this bill. It helps to level the playing field for all consumer-selected Accounting Coordinator health products (prescription drugs have had this responsibility for many years). The genesis of this new bill goes back several years to the public debate on the safety of the controversial herb ephedra (Ephedra sinica), when media and legislators were highly vocal about their criticisms that the OS industry was not required to report AERs related to the controversial herb. This issue was particularly exacerbated after revelations that a major ephedra supplement manufacturer, Metabolife International, had withheld from the FDA the thousands of reports from consumers (the company called them mere "incident reports," but they were perceived as potentially adverse by regulator critics and the media); eventually a much smaller number of reports were deemed "serious." If this bill becomes law, the major challenge will be setting up a reporting system for serious AERs-one properly designed to ensure adequate and accurate collection of information with ;AMERICJtN the ability to determine potential associations between the events and the dietary supplement ingredients or the OTC drugs. BoTANICAL As Prof. Rick Kingston and I wrote in our Herba/Gram 60 article on the deficiencies of the COUNCIL American Association of Poison Control Centers Toxic Event Surveillance System, "Collection of spontaneously reported botanical AERs in a systematic and consistent manner is a vital part of product stewardship and safety assurance. Defining and monitoring the safety of dietary Mission: Provide education supplements is a dynamic process, and cooperation among multiple stakeholders using reliable using science-based and traditional methods of surveillance and analyzing collected data in proper context will aid in this process." information to promote responsible [For more information, see the July issue of HerbalEGram at www.herbalgram.org.] HG use of herbal medicine-serving the public, researchers, educators, healthcare professionals, industry, and media.

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Number 71 • August, September, October 2006 features Contributing Writers Joanne Barnes Alessandro Boesi Claire Bombardier Heather Boon Francesca Cardi Cynthia Crimmins Joan C. Engebretson Grant K.L. Ferrier Joel J. Gagnier The small town of Litang, Joyce Juan capital of the Litang County. The authors conducted Vincent Lebot extensive fieldwork in this Brenda Milot region (Sichuan, China), David Moher 4000 meters altitude, June John Neustadt 1999. Marissa Oppel Photo ©2006 Alessandro Katherine Purcell Boesi Paula Rochon The Quality of Kava Consumed in the South Pacific Armando Gonzalez Stuart by Vincent Lebot Sidney Sud berg The medicinal and ritual plant kava remains an important crop within various South Pacific countries, both Jennifer Terrazas for its economic value and its local use. Despite bans on the sale of kava in some European nations starting in 2001, kava is still exported to other countries and is widely sold within the region to satisfy the local Herba/Gram Staff 34 kava-drinking market. This article examines the many factors that can affect the quality and safety of kava Mark Blumenthal preparations, including differences in kava chemotype and kava lactone content, the selection of plant parts used, and the Editor I Publisher methods of preparing kava. It further explores trends and practices of kava preparations and consumption in South Pacific communities. Michael Finney Managing Editor Tibetan Herbal Medicine: Traditional Classification and Utilization of Sean Barnes Natural Products in Tibetan Materia Medica Art Director by Alessandro Boesi, PhD, and Francesco Cardi, PhD Courtney Cavaliere Tibetan traditional medicine is a complex and heterogeneous system of healing, based upon the blending Assistant Editor of several traditions from prominent Asian medical sciences. The authors of this article conducted fieldwork over a period of 16 months, analyzing how medicinal substances are identified and used by Tibetan medical Steven Foster 38 Associate Editor practitioners. They found that these practitioners typically distinguish medicinal plants through such factors as plants' minute morphological features, plants' taste and scent, and environmental indicators. The authors further explain the Rakesh Amin inter-related influences of Tibetan medical texts, doctors' individual knowledge and traditions, and common categories of Legal & Regulatory Editor Tibetan materia medica in the classification and use of medicinal plants. Maureen Jablinske Improving the Quality of Reporting Randomized Controlled Trials Evaluating Herbal Proofreader Interventions: Implementing the CONSORT Statement Nancy Dennis by Joel J. Gagnier, NO, MSc, PhD (Candidate); Heather Boon, PhD; Paula Rochon, MD, MPH; David Moher, PhD; Editorial Assistant Joanne Barnes, PhD, MRPharmS, FLS; and Claire Bombardier, MD Madeline Hollern The CONSORT Statement, first published 10 years ago and endorsed by many leading medical journals, helps Editorial Intern guide authors and researchers in their reporting of randomized controlled trials (RCTs). The authors of this Lance Lawhon article provide recommendations for elaborating certain items of the CONSORT Statement to assist researchers 50 in giving more complete reports of RCTs featuring herbal medicine interventions. These recommendations, Advertising Sales 877-832-1881 achieved through a collaboration of experts, are intended to further improve the quality and coherence of reported RCTs on [email protected] herbal preparations and their results. departments

10 ABC News 68 Book Reviews Neil Blomquist Joins ABC Board ofTrustees Herbal Diplomats: The Contribution of Early American Nurses (1830-7860) to Nineteenth-Century Health Care Reform and the ABC Dedicates Trees to Alfred Blumenthal Botanical Medical Movement ABC Employee Profile: Aileen Truax Poisonous Plants: A Handbook for Doctors, Pharmacists, Toxicologists, Biologists, and Veterinarians, 2nd Edition 12 Organization News Handbook of Analytical Methods for Dietary Supplements Sponsors and Participants Build Momentum for HerbDay New Book Profiles John Weeks Writes Integrator Blog News and Reports NAPRALERT Herbal Database Available on Internet 72 In Memoriam Gladys lola Tantaquidgeon 17 Grants & Awards Edward Peterson Libster Honored with Lavinia L. Dock Award for Herbal Nursing Book Jeannine Parvati Baker Rutgers University Receives Grant for Germ plasm John W. Thieret Developments in Africa William J. Oswald Two Island Conservationists Receive Seacology Awards Floyd Edwin Leaders, Jr

20 Research & World News Tom Ferguson NCCAM Funds New African and Chinese Herbal Research 78 Ca lendar Programs Global Horticulture Initiative to Improve Health and Economies 79 Access of Developing Countries ~ Gum Arabic Industry Members Commit to Sustainability 80 Classifieds

26 Research Reviews Corrections Trial Suggests Saffron's Potential to Treat Mild to Moderate Preserving Ayurvedic Herbal Formulations by Vaidyas written by Depression Chandra Prakash Kala, published in HerbaiGram 70; correction appears on page 24. Andrographis, Asian Ginseng, and Valerian Extracts Tested in Small Trial on Male Fertility Government Increases Restrictions on Wild American Ginseng Export by Mark Blumenthal, published in HerbaiGram 70; correction Trial Suggests Efficacy of Pomegranate Juice on Myocardial appears on page 26. Perfusion JimsonWeed: History, Perceptions, Traditional Uses, and Potential ABC Clarifies Recent Meta-analysis of Milk Thistle Clinical Trials Therapeutic Benefits of the Genus Datura by Kofi Busia and Fiona Special Extract ofTraditional African Herb Pelargonium Treats Heckels, published in HerbaiGram 69; correction appears on page 77. Bronchitis in Clinical Trial On the Cover 58 Legal & Regulatory A Tibetan traditional doctor evalu­ WHO Surveys Worldwide Patterns of Herbal Regulations ates the taste of'dzin pa zla bra/ Australian TGA Publishes Liver Warning Policy for Black Cohosh (pronounced: zin pa da drel), Aconitum gymnandrum, in the Supreme Court Ruling Protects Religious Group's Access to mountains surrounding the town Ayahuasca of Utang, Litang County (Sichuan, China), 4090 meters altitude, July 64 Market Report 2000. Photo 2006 ©Alessandro Boesi. Total Sales of Herbal Supplements in United States Show Steady Growth

Subscriptions to Herba/Grom are a benefit of ABC membership at every level. One year memberships: Individual $50; Academic $100; Professional $150; Organization $250; Retailer $250; HerbCiip Service $500; Corporate; Sponsor. Add $20 for memberships outside of the US. Student and Senior discounts are available. For information about Corporate or Sponsor Memberships, contact Wayne Silverman, PhD, at [email protected] or 512-926-4900. © 2006 American Botanical Council. ISSN #0899-5648. Printed in the U.S.A. HerbaiGram• is pflnted on recycled paper at The information in Herba/Gram• is intended for educational purposes only and is not a substitution for the advice of a qualified healthcare professional. Although Branch-Smith Printing, we attempt to ensure that advertising in Herba/Grom is truthful and not misleading, the publication of an ad for a product or company in Herba/Grom does not Ft. Worth, Texas constitute an endorsement by ABC of the product or the company being advertised. Publication of an ad that makes a health claim or structure-function claim does not necessarily constitute an approval of that claim by ABC. Further, ABC has not reviewed any manufacturer's Good Manufacturing Practices. ABC News

Neil Blomquist Joins ABC Board of Trustees he American Botanical Council (ABC) is pleased to announce the addition ofNeil Blomquist to its Board ofTrustees. Mr. Blomquist brings over 30 years experience in the natural products industry as a business owner and manager. He is intimately T familiar with the challenges that manufacturers face in ensuring a supply of quality ingredients as well as understanding the workings of the organic products industry.

For the past twelve years, Mr. Blomquist has been an executive "Neil's experience running a publicly-traded company is a of Spectrum Organic Products, Inc. in Peta­ welcome addition to our Board," said Wayne Silverman, PhD, luma, California, the nation's largest marketer Chief Administrative Officer of ABC. "His background will help of organically-produced vegetable oils for improve ABC's future from the management and finance perspec­ cooking, salad dressings, dietary supplements, tives." and related food uses. With the recent acquisi­ Blomquist's tenure on the ABC Board began at the March tion of Spectrum by the Hain-Celestial Group board meeting. He participated at the board's recent meeting in 2005, Mr. Blomquist will be leaving Spec­ in Anaheim, California, during the Nutracon education confer­ trum to pursue other business and personal ence and the Natural Products Expo West conference and trade interests. He will be working with the new show. HG management team as a strategic consultant Blomquist t h roug h 200 6 to h e Ip wit h t h e transition o f the brand. "I am honored to have been asked to join the ABC Board," said Blomquist. "I firmly believe that the work of ABC has played an important role in helping grow the role of herbs in our society and also to help maintain the values that have been the driving force behind this movement. I look forward to helping ABC in moving its agenda into the future." Originally from Montana and South Dakota roots, Neil Blomquist has been involved in the natural foods industry since its early days in the 1970s. After earning a bachelor's degree in management and economics from the University of South Dakota, School of Business, Neil and his wife Monica, opened a natural foods market in Montana where they both learned the invaluable retailer's perspective firsthand. In 1985 they moved to Sonoma, California. Neil began working for the natural foods distributor Landstrom-Phoenix, where he learned the wholesaler's perspective. Remaining true to his natural foods and whole health roots, Neil sought a career path that would keep him working in Nate Sponseller (ABC Gardener), Gayle Engels, and Mark Blumenthal. a values-driven business environment. He joined Spectrum in Photo ©2006 ABC. 1989 as director of sales and marketing and continued his career in learning the natural products production chain from retail to ABC Dedicates Trees to Alfred wholesale to manufacturing and sourcing. Drawing upon his prior experience to develop new logos, prod­ Blumenthal uct lines and marketing strategies, Neil's management experience he American Botanical Council (ABC) expanded and commitment to natural foods helped catapult Spectrum to its tree garden in June when ABC Board of Trustees a higher level of sales and wider distribution. At Spectrum, Neil and staff dedicated 2 trees in memory of Founder exhibited his passion for and commitment to sourcing premium­ T and Executive Director Mark Blumenthal's father, Alfred quality oils and ingredients, including the development of Spec­ A. Blumenthal, a watercolorist, who died in May at age 94. trum's premium quality flaxseed oil line, organic seed oils, organic The trees chosen to honor Mr. Blumenthal's full, creative apple cider vinegar, and organic dressings and mayonnaise. life are a bur oak (Quercus macrocarpa) and a southern In 1994, Neil became Spectrum's President and Chief Operat­ magnolia (Magnolia grandiflora). The bur oak is a slow­ ing Officer. The acquisition of Organic Food Products in 1998 growing native Texas oak that could ultimately reach 100 led Spectrum to its status as a public company. In 2002, Neil feet in height and spread. The southern magnolia, which became Chief Executive Officer and President of Spectrum. has fragrant white flowers that bloom in May, will serve "We at ABC are honored and grateful for Neil's decision to join as a reminder of Mr. Blumenthal's life through the Jewish us in guiding ABC over the coming years," said ABC Founder tradition of Yahrzeit, in which the deceased person's life is and Executive Director Mark Blumenthal. "Neil brings with him celebrated each year at the anniversary of his passing. HG a wealth of experience in business management on the food side - Gayle Engels of the natural products and organic industries, which will benefit ABC in many important ways."

10 I HerbaiGram 71 2006 www.herbalgram.org ABC News

ABC Employee Profile: Aileen Truax ileen Truax, the Development and Marketing Coordinator of ABC, is a shining example of the great value in our society of the tireless nonprofit manager. The nonprofit world is different from the commercial, for-profit sector of society in numerous Aways. One of the main aspects that characterizes this difference is the fact that nonprofit organizations are essentially commit­ ted to enhancing the greater good in some measurable manner, without any real direct or financial benefit accruing to those who work for the nonprofit other than a modicum of remuneration. There are no stock options, big bonuses, or huge salaries involved in the nonprofit world. The primary benefit is that nice warm feeling one gets when he or she recognizes the personal and professional contribution that improves people's lives, the social order, the environment, etc.

What distinguishes Aileen Truax is her total commitment to fits; overseeing member/donor communication including pros­ the nonprofit culture. Aileen is no stranger to the nonprofit world. pecting, soliciting, invoicing, recognition, acknowledgement, and It's been part of her life's passion since high school in Houston, renewal; developing and executing media/marketing activities for where she braved leading a fund raising campaign at her school membership programs and initiatives; researching and writing for an Ethiopian relief effort, to the chagrin grant proposals to fund ABC's educational projects; developing of the school administration. Aileen contin­ public relations activities; overseeing ABC's vast web-based educa­ ued to volunteer with various nonprofit groups tional content licensing program, including online content sales, throughout college. After working in the for­ set-up, and maintenance; budgeting of marketing and member­ profit sector for several years, she made a deci­ ship departments; and creating the donor management process. sion to seek a career with nonprofit organiza­ ABC is obviously a much richer and well-functioning organiza­ tions, using the experience she had gained as a tion due to Aileen's tireless efforts, and ABC's members are also volunteer. She later worked as the development richer as she propels ABC's nonprofit mission to enhance every­ director at the High Country News, a biweekly one's health, naturally. HG Truax environmental newspaper in Colorado cover- -Mark Blumenthal ing the environmental issues in the inter­ moumain West, before becoming development director for over two years of the Lone Star Chapter of the Sierra Club in Austin, Texas-a legislation-oriented chapter focused on Texas-specific issues. Since arriving at ABC late in 2004, she has dedicated herself to increasing benefits to ABC members, especially to ABC's "core" members, the individuals like the consumers, academics, health professionals, and others who comprise the vast majority of ABC's membership. At ABC, Aileen shares responsibility for all aspects of donor and member cultivation, acquisition, retention, management, and communication. She not only supervises staff members who comprise the membership services ream, bur she also has taken charge of a major overhaul of ABC's Internet site to enhance the user-friendliness of the access to ABC's online presence. Her additional duties include helping to create development goals and implement strategies for achieving them; coordinating develop­ ment, communication, and distribution of annual member bene-

www.herbalgram.org 2006 HerbaiGram 71 I 11 Sponsors and Participants Build Momentum for HerbDay erbDay 2006 is just a few months away and numerous sponsors and participants are already planning an exciting array of events to celebrate herbs and herbalism at sites all across America. Reports of events and offers to become involved are H increasing as people and companies are beginning to register at the event's Web site: www.herbday.org. There are three HerbDay Corporate Sponsors: General Nutrition Centers (GNC), a global retailer of nutritional supplements; Nature's Resource Herbal Supplements, sold in food and drug stores nationwide; and Vitamin World, a seller of nutritional and herbal supplements direct from the manufacturer. All will promote activities in key cities across the country. Several retailers, large and small, will partic­ ipate as HerbDay hosts, either on HerbDay itself (October 14) or on the days just before and after. The extensive GNC chain is plan­ ning a variety of store-based activities all month and special offers to honor the day. Vitamin World will promote and publicize the day at its 480 stores and through its publications, and another retail chain, Vitamin Shoppe, will hold events in all of its 280 stores to highlight the value of herbs. Herbs Etc., a manufacturer, will host Herb Day activities in its Santa Fe, NM, store and community. Great Earth Vitamins, another retail chain, based in Ontario, CA, and Nature's Sunshine, a large manufacturer of herb products based in Provo, UT, will also host HerbDay activities.

Beyond the retailer arena, the San Robin DiPasquale, and Bevin Clare are HerbDay. NNFA has created an HerbDay Diego Herb Club and that city's chapter scheduled to offer free classes to the public committee to help inform retailers of the of the American Herbalists Guild (AHG) on herbal topics at the United States event, and the organization provided an are joining together to plan an informa­ Botanic Garden in Washington, DC, HerbDay booth at its 70th anniversary tional fair in Balboa Park, including tours from October 13-14. Twenty students annual trade show in Las Vegas in July. of the newly expanded "Trees for Health" from the Tai Sophia Institute in Colum­ The herb trade media, meanwhile, have medicinal tree grove and garden. In Ben bia, MD, are planning to set up discovery expressed support for HerbDay through Lomond, CA, the East-West School of stations on their campus, with 6 students their plans to promote the event to read­ Herbology will also participate. Further delivering lectures on various herb-related ers. Ads and editorials will be run well in east, Herbalists Without Borders (based topics. The National Nutritional Foods advance of the event and up to October in State College, PA) will host an "Herb­ Association (NNFA), the Herb Soci­ by the following Media Sponsors: Health alSlam"-a poetry contest on the theme ety of America, Bastyr University, Tai Supplement Retailer, Remedies, Vitamin of "a ll things herbal." Renowned herbal Sophia Institute, and the International Retailer, Health Smart Today, Whole Foods experts Aviva Romm, James Duke, PhD, Herb Association will also participate in Magazine, and Natural Foods Merchan­ diser. In addition, Taste for Life will publish a special edition in October that includes a 24-page pullout section with articles by respected herbalists. This special edition will offer leading manufacturers an excel­ lent opportunity to support consumer education through advertisements. Five national nonprofit organizations­ American Botanical Council (ABC) ;Amer­ ican Herbalists Guild (AHG); American Herbal Pharmacopoeia (AHP); American Herbal Products Association (AHPA); and United Plant Savers (UpS)-have been working together as the HerbDay Coali­ tion to launch this event. The entire herbal community is invited to partici­ pate actively in HerbDay 2006, either by hosting an event or providing sponsorship in the form of financial support. More information about HerbDay activities and resources, including a menu of ideas for individual events and registration forms for prospective participants, is available at the Web site: www.herbday.org. HG -Gayle Engels and Courtney Cavaliere

12 I HerbaiGram 71 2006 www.herbalgram.org Vita Plant

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John Weeks Writes Integrator Blog News and Reports he herbal medicine movement is part of a much larger social trend in self-care and healthcare that includes many other natural and traditional medicine modalities. The inclusion of these complementary and alternative medicine (CAM) modalities into T standard practice or conventional medicine has become known as Integrative Medicine, a term originally coined by noted author and spokesperson Andrew Weil, MD.

One of the key people involved in and natural products. Among the contents was involved with the early maturation moving the integration process forward of the premier iss ue, for example, are of the American Herbal Products Asso­ has been John Weeks, an advocate and articles and comments on the following: ciation, serving on its board for a period. catalyst for increased communication and efforts to reform the chiropractic profes­ From the 1990s until 2002, he was a collaboration among various individuals sion, the Sravewell Collaborative-backed writer, organizer, consultant, and speaker and organizations involved in CAM. His PBS show The New Medicine, two new on the business of integration, engaged in former publication, Integrator for the Busi­ professional training programs, an inter­ diverse projects that informed his report­ ness of Alternative Medicine, was viewed view with the chair of the Consortium of ing and commentary. by many as the journal of record for the Academic Health Centers for Integrative Weeks writes in his blog: "In default emerging field of integration. After several Medicine, an initiative to explore CAM mode, most of us focus on the particu­ years of sabbatical with his fam ily in in reducing health disparities, and the lar challenges of our own disciplines or Costa Rica, Weeks is back in the United multi-disciplinary traditional and alter­ stakeholder groups. We return to the States and has re-entered the CAM dialog, native medicine practitioners' project to known. Integration, by nature, asks us to this time with a web log (blog). develop a proposed new strategy for regu­ open our peripheral visions. We are served "The Integrator Slog News and Reports" lating herbs as "traditional medicines" to look at the whole of the field. We need is a new online newsletter (www.thein­ in the United States (i.e., the Traditional to develop new fascia, new connectiv­ tegratorblog.com) and discussion forum Medicines Congress). ity. Opportunities crop up in new places. which focuses on building the community Weeks is no stranger to the herb commu­ These News and Reports are meant to be of interests among all who are involved in nity. While serving as a vice president at a kind of one-stop shopping to help you in the fields of integrative medicine, CAM, Bastyr University in the late 1980s, Weeks your efforts to enhance integrated care in the environment you serve." The Integrator Blog also includes forums and a poll. Weeks said he plans to "work Earn a with our networks to bring as many of the Master of Science leaders in the field to the site as possible to stimulate the cross-pollination of ideas in Herbal Medicine and action." Weeks acknowledges that the most read ADVANCED STANDING section of the site to date is his brief CORE & RESIDENTIAL FACULTY NOW AVAILABLE FOR report on his 3-year (2002-2005) work­ EXPERIENCED HERBALISTS Simon Mills, MA, FNIMH, MCPP, ing sabbatical with his family in Central Director of Herbal Medicine Program America. He started The Integrator Slog 800 HOURS OF EXTENSIVE upon his return. {It wasn't all sabbati­ CLINICAL TRAINING & PRACTICUM James Snow, Chair-Herbal Division (A HG ) Kevin Spelman, BS, RH (AHG), MCPP cal. From home offices in Monteverde, Noll' enrolling for Fall2006! Chair-Clinical Division Costa Rica, then Granada, Nicaragua, he Claudia Joy Wingo, BSN, DMH directed the National Education Dialogue Acting Chair-Clinical Division to Advance Integrated Health Care: Bevin Clare, BS, RH (AHG) Creating Common Ground, an initiative James Duke, PhD which involves educators from 12 disci­ Tina Lightner, MS, RH (AHG) plines.) Other useful resources on the site are back-issues of Weeks' electronic News VISITING FACULTY Files, 2 reports on Integrative Medicine Industry Leadership Summits, a prog­ 7Song, RH (AHG) ress report from the National Educa­ Mary Bove, ND, CPM tion Dialogue, and papers he was asked Tai Sophia Jerry Cott, PhD to write on coverage issues by the White Institute Steven Dentali, PhD House Commission on CAM Policy and Jill Stansbury, ND the National Institutes of Health. The www.tai.edu Roy Upton, RH (AHG) News and Reports are offered for free, 800-735-2968 ext. 6647 David Winston, RH (AHG) although Weeks asks readers to consider a voluntary subscription. HG [email protected] Eric Yarnell, ND

14 I HerbaiGram 71 2006 www.herbalgram.org Burgundy Botanical Extracts

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NAPRALERT Herbal Database Available on Internet searchers, clinicians, journalists, and others wishing to access extensive scientific and clinical literature about herbal medi­ cine and related subjects now have access to one of the best research tools available. T he University of Illinois at Chicago R UIC) has announced the availability of its highly respected NAPRALERT database on the Internet effective April 26, 2006. The site is available at www.napralert.org.

NAPRALERT, the world's largest database on herbs and resource, often pointing us to papers that were not available medicinal plant research, contains information from over 200,000 anywhere else. Now that NAPRALERT is available on the Inter­ publ ished studies in the fie ld of natural products, covering numer­ net, the world of medicinal plant research just became bigger and ous related scientific disciplines. T hese papers represent research easier." on plants and animals from all countries of the world, incl uding During the pas t 30 years, NAPRALERT's primary clients have marine organisms, plus the geographic origin from where they been universities, the Food and Drug Administra tion, the World were obtained. Health Orga nization, fo reign gove rnments, and other research T he name NAPRALERT is an acronym fo r "Natural Pro ducts and educational institutions. T he new Internet accessibility will Alert." T he ori ginal intention of the database was to compile a allow individuals enhanced access to the data in the unique data­ collection of the world's scientific literature on natural products base. used for health purposes and the development of new medica­ About 25% of the NAPRALERT database is derived from tions. Most, but not all, of the natural products included in abs tracts (s hort summaries of research) and 75% from original the database are herbs and botanically-derived ingredients and articles. In the pas t, the UIC researchers have had the occasion phytochemicals. to acquire complete literature on about 250 ge nera of plants and According to Professor Norman R. Farnsworth, PhD, Research these data appear in NAPRALERT. T he ea rlies t papers date as far Professor of Pharmacognosy and Senior University Scholar at back as the late 1800s. UIC , "NAPRALERT is a relational database of all natural prod­ NAPRALERT's coverage of the scientific literature is extremely ucts, including a wide ra nge of research on ethnomedical infor­ comprehensive, especially in the following areas of research: mation, and pharmacological and biochemical information of • C linical studies of natural products (including safety) extracts of animal and plant organisms. T he research includes • Natural products that affect sugar metabolism in vitro (experimental laboratory) studies, in vivo (a nimal stud­ • Natural products that affect mammalian reproducti on ies), human case reports and non-clinical trials related to human • Extracts and compounds that affect cancer growth use, and controlled and uncontrolled human cl inical trials. Simi­ • Natural products and antiviral (including HIV/AIDS) lar information is ava ilable for secondary metabolites [natu­ activity rally occurring chemicals in plants and animals] from natural • Natural products and antitubercular acti vity so urces ." • Natural products and tro pical diseases In 1975 Professor Farnsworth and his colleagues at U IC began • Ethnomedical information on more than 20,000 species of a systematic search of the scientific and clinical literature by plants examining every journal pertinent to natural products in the UIC • Metabolism and pharmacokinetics Health Science Library. Years later they began viewing the table • Natural products that affect plant growth of contents of a large number of journals from the Internet on a • Biosynthes is of natural products regular (monthly) basis. T hese journals were selected from a list • Review articles on organisms at the genus and/or species of journals that historically the UIC researchers knew contained levels and reviews of secondary metabolites (citations only) pertinent data for the NAPRALERT system. In addition, rele­ • Chemoprevention (cancer preve ntion) with natural products va nt sections of Chemical Abstracts, particularly the Biochemistry • Natural insecticides Sectio n, were examined for articles not found in the U IC Library • Anti-inflammatory activity of natural products sources and original articles were obtained via interlibrary loans. • Analgesic activity of natural products Professor Farnsworth added, "We are fo rtunate also to have many T he UIC notes that when a visitor to the NA PR~LERT site foreign journals in which articles are rarely fo und through the is seeking information on biological activity categories, there are usually accessible natural product scientific literature so urces ." many closely related biological targets that might relate to a single Accord ing to Farnsworth, NAPRALERT's coverage of the endpoint. If visitors cannot retrieve biological data on an activ­ li terature is comprehensive from at least 1975 through and includ­ ity that they desire, they are urged to contact the NAPRALERT ing 2003. D ue to budget res tric tions, the resea rchers were able team by e-mail (ushab@ uic.edu), and someone will attempt to to include only about 15% of the releva nt botanical and natural provide assistance. product literature from 2004 and 2005. Articles are currently Free sa mple sea rches are available on the NAPRALERT site on bei ng coll ected, and it is hoped that they eventually will be the Internet to show the types of information available. HG incl uded in the revised database. "T his is a real bonus to the herb research community," said Mark Blumenthal, Founder and Executive Director of the Amer­ ican Botanical Council. "For many years, we have relied on the NAPRALERT database for many of our research needs. It has been a unique and most va luable educati onal and research

16 I HerbaiGram 71 2006 www. herbalgram .org Grants &Awards

Libster Honored with Lavinia L. Dock Award for Herbal Nursing Book he American Association for the History of Nursing (AAHN) has named Martha Libster, PhD, RN, a recipient of the orga­ nization's 2005 Lavinia L. Dock Award for her book, Herbal Diplomats: the Contribution of Early American Nurses (1830- T 1860) to 19th Century Health Care Reform and the Botanical Medical Movement1 T he award was presented at AAHN's annual conference in Atlanta, GA, September 23-25, 2005.2 Dr. Libster is an associate professor of nursing and history at Purdue University, an experienced herbalist, and a newly-appointed member of the American Botanical Council Advisory Board.

HerbaL Diplomats explores the healing procedures and histories manuscripts will be honored of 3 groups of female nurses who practiced herbalism in America through the newly created Mary during the mid-19th century: the Shaker infirmary nurses, the Adelaide Nutting Award. Latter-day Saints {Mormon) pioneer nurses and midwives, and Dr. Libster is currently work­ the Sisters of Charity hospital nurses. 1 The ing on 2 books that will further book initially served as Dr. Libster's docroral address women's ea rly contribu­ thesis, which she completed at Oxford tions to healthcare, including Brookes University in Oxford, England, their work with botanicals. One graduating in July 2004 (M. Libster, oral manuscript wil l expand upon communication, January 2006). the profile of the 19th century Dr. Libster decided to pursue such Sisters of Charity (now referred research after she discovered that pre-exist­ to as the Daughters of Charity) ing scholarly works regarding the botani­ contained within Herbal Diplo­ cal medical movement gave little or no mats. This new book will high­

Libster mention of women's role within herbalism li ght the group's work within of that period. "! found a gaping hole in our holistic psychiatric nursi ng and history of herbal medicine," she explai ned. "Being a woman histo­ moral therapy. She is also compil- rian and an herbalist, I really wanted to fill that gap." ing an oral history of a Mohawk medici ne woman. HG She had some prior knowledge of the histories of the 3 groups -Courtney Cavaliere she chose to study and had a hunch that further data could be uncovered. She ultimately pieced together community records, References nurses' instruction manuals, recipe books, letters, and archi­ I. Herbal Diplomats page. Golden Apple H ealing Arts Web site. val records to present cohesive case-studies of the 3 groups of Ava il able at: http:/ /www.goldenapplehealingarrs.com/ index.cfm/ nurses.3 "I was told by some scholars that it would be a needle in page/prype=product/product_id=921ca tegory_id=63 /home_id=-l I mode=prod/prd92.htm. Accessed January 5, 2006. a haystack, and that I wouldn't find anything," Dr. Libster said. "I 2. Titles and Presenters at Past AAHN Conferences page. American actually found so much data that I never reached a point of satu­ Association for the History of Nursing Web site. Available at: ration. I could be working for 3 lifetimes on what I found. It was http://www.aahn.org/pastconf.html. Accessed January 10, 2006. like finding buried treasure! " 3. Libster M. Herbal Diplomats: the Contributions ofEarly American AAHN is the United States' national organization for nurse Nurses (1830-1860) to 19th Century Health Care Reform and the historians. From 2001 to 2005, the organization has presented 2 Botanical Medical Movement. West Lafayette, IN: Golden Apple Dock Awards annually to researchers whose manuscripts demon­ Publications; 2004. strated exceptional, original research within the historical nurs­ 4. Awards page. American Association for the History of Nursing Web site. Available at: http://www.aahn.org/awards.html. Accessed Janu­ ing field-one awarded for a book and the other for an article or ary 5, 2006. relatively short manuscripr.4 Beginning in 2006, the Dock Award will only be given to the author of a book. All future article-length

Nutraceutical

Adding value through science to botanicals used in complementary and alternative medicine www.phytosynergy.com c/o Missouri Innovatio n Center, Inc. [email protected] University of Missouri-Columbia CELL : (573) 356-7372

www.herbalgram.org 2006 HerbaiGram 71 I 17 Rutgers University Receives Grant for Germplasm Developments in Africa he New Use Agriculture and Natural Plant Products Program at Rutgers University has received a major grant to foster agri­ cultural development in southern Africa. The Program was allotted $880,000 over a 2-year period by the Association Liaison T Office for University Cooperation in Development (ALO) to study genetic materials of native nontraditional south African crops-including teas, herbs, medicinal plants, and vegetables-as well as the development of a germplasm (seed) database and pilot germplasm banks. Additionally, the program will promote advances for farmers and seed companies through training and advocacy efforts and identify specialty vegetables and herbs for introduction into other countries. 1

The principle leaders of this project This is the second major gram that the References are James E. Simon, PhD, and Hisham Rutgers program received within a year I. Rutgers-Cook College researcher receives Moharram, PhD, of Rutgers. Co-prin­ for herbal medicine development work second grant to promote agricultural ciple investigators include H. Rodolfo in Africa. Only a few months before development in southern Africa [press the ALO grant was announced in Janu­ release]. New Brunswick: Rutgers Univer­ sity; January 26, 2005. Available at: THE STATE UNIVERSITY OF NEW JERSEY ary 2005, Rutgers was awarded a major grant of $2.5 million from the United http:/ /www.cookn jaes. ru tgers .ed u/ news/ release.asp)n=295. Accessed Apri l 24, States Agency for International Develop­ 2006. RUTGERS ment (USAID), a partner of AL0.2 The COOK COLLEGE 2. Blumenthal M. Rutgers University USAID grant was made to develop value­ receives gra nt from USAID for natu­ added food products and establish safety ral products development in Africa. Juliani, PhD, and Mingfu Wang, PhD, of and quality standards for food products in HerbalGram. 2005;No. 65:19,66. Rutgers, along with Petrus Langenhoven, African and international markets. HG Available at: http://www. herbalgram. PhD, of the University of Stellenbosch in -Courtney Cavaliere org/herbalgram/articleview.asp?a=2767. South Africa, and Prof. Davies Lungu of Accessed April 24, 2006. the University of Zambia.

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As old as Chinese culture itself, the use and effect of herbal medicine has been studied and documented for thousands of years.

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Developments such as these are now available for license, sale and co-development. Visit www.biotechtransfer-taiwan.com for details of the latest technology transfer opportunities in herbal medicine, as well as drug development, medical devices, biomaterials, and more.

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18 I HerbaiGram 71 2006 www.herbalgram.org Grants & Awards

Two Island Conservationists Receive Seacology Awards by Courtney Cavaliere

wo dedicated environmental advocates were recently honored by the nonprofit organization Seacology for their work preserv­ ing island ecosystems.1 Patrick Danaya Pate of Papua New Guinea was awarded the organization's 2005 Seacology Prize and T Felix Sugirtharaj, PhD, of India received a special Seacology Lifetime Achievement Award at a ceremony held October 25, 2005, in San Francisco, California.

Pate is vice president of the Kosua Oro go "Mr. Danaya Pate has courageously Resource Holders Association (KORA), fought logging of the primeval rain forests an environmental organization of Papua of Papua New Guinea by journeying alone New Guinea's Mt. Bosavi region. He was from village to village to inform the honored with the Seacology Prize for his people of the devastation that logging will work in organizing indigenous communi­ bring," said Paul Cox, PhD, chairman ties against industrial logging. The forests of the Seacology Board (e-mail, Febru­ ary 7, 2006). "His efforts originate from his heart, with no hope of recognition or outside approval." Pate also serves as community facilitator of the Sulamesi Resource Development Foundation-an Paul Alan Cox and Dr. Felix Sugirtharaj, who was organization that promotes sustainable awarded a special Lifetime Achievement Award. development and livelihood improvement Photo ©2006 Seacology. in the Mt. Bosavi region. 1 odds an extremely high level of education, Dr. Sugirtharaj, director of the and he has used his education to bene­ Coastal Poor Development Action fit his own people by teaching them to Network, received the Lifetime Achieve­ protect their environment," said Dr. Cox. ment Award for his efforts in protecting Dr. Sugirtharaj was also recognized mangrove forests of the Andaman Islands. 2005 Seacology Prize ceremony. At left is Seacol­ for his charitable actions following the Mangroves are woody trees or shrubs that 1 ogy President Ken Murdock, center is 2005 Sea col­ December 2004 tsunami. He helped ogy Prize recipient Patrick Pate, and at right is grow in tropical coastal habitats, which assess local damage to nearby commu­ Seacology Founder and Chairman Dr. Paul Alan often protect coastlines from erosion and nities, distributed resources to suffering Cox. Photo ©2006 Seacology. support marine life. He recently coordi­ families, and supervised the rebuilding nated the establishment of a Seacology­ of local homes. "His efforts to help the of Papua New Guinea have been increas­ funded mangrove resource center in the victims of the recent tsunami were heroic," ingly threatened in recent years by logging village of Kadakachang, near the Anda­ said Dr. Cox. proposals, and KORA's advocacy efforts man capital of Port Blair. 2 Construc­ Both award recipients were given mone­ have led many community members to tion of the center was completed in late tary prizes of $7,500. The Seacology Prize reject proposals from the logging industry. 2005. "Born as an untouchable, [Dr. has been awarded annually since 1992 Indigenous communities recently set aside Sugirtharaj] has achieved against great to an indigenous islander committed to a total of 1.25 million protecting his or her culture and environ­ acres of pristine forest ment. Dr. Sugirtharaj's Lifetime Achieve­ as 5 Wildlife Manage­ ment Award, which is not an annual ment Areas (WMAs), Seacology award, was sponsored by Nu for which Seacology Skin Enterprises of Provo, Utah (P. C ox, funded the construc­ e-mail, February 7, 2006). HG tion of3 local resource centers in 2003. Pate References has coordinated that I. Community organize r from Papua New building project and Guinea and Indian mangrove conser­ helped ensure contin­ vationist to receive Seacology awards ued protection of the [press rel ease]. Berkeley, CA: Seacol­ WMAs. Seacology ogy; September 8, 2005. Ava il abl e at: http://www.seacology.org/ news/ display. regularly initiates and cfm ?id= 173. Accessed February 6, 2006. sponsors projects that 2. Island Projects page. Seacology Web site. preserve the environ­ Ava ilable at: http://www.seacology. org/ ments and cultures Patrick Pate (in headress) speaks with Seacology Executive Director Duane projects/individualprojects/AN DAMAN­ of islands throughout Silverstein (right) and Musala Villagers during the 2004 Sea co logy expedi­ ISLAN DS2004. htm. Accessed February the globe. tion to Papua New Guinea. Photo ©2004 Jon Stansbury 10, 2006.

www.herbalgram.org 2006 HerbaiGram 71 I 19 NCCAM Funds New African and Chinese Herbal Research Programs he National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) has announced the funding of 3 new Centers of Excellence and 2 International Centers for the study of traditional herbal medi­ T cines and other forms of complementary and alternative medicine (CAM). Both traditional African and Chinese that thes~ researchers apply "cutting-edge Chinese medicine (TCM) approaches herbal medicines, particularly traditional technologies" to identify the potential (i.e., acupuncture and herbs) for the treat­ herbal combinations, will be included benefits and underlying mechanisms of ment of arthritis. Researchers will conduct in the research being funded in the new CAM practices. The 3 new centers are a clinical rrial of the 11-herb Chinese cenrers. Other modalities include acupunc­ described below. formula Huo-Luo-Xiao-Ling Dan (known ture and a type of energy medicine (milli­ as HLXL) for osteoarthritis of the knee, meter wave therapy). as well as assess acupuncture's effect on According to an NCCAM press release NCCAM states inflammatory pain in an animal model, dated October 14, 2005, with these new and study the efficacy of HLXL in an awards "NCCAM conrinues to enhance that these researchers animal model of autoimmune arthritis. CAM research capacity by funding cenrers apply "cutting-edge The herbal components of HLXL are at leading US institutions and by estab­ shown in Table 1. HLXL was developed lishing new global partnerships."! technologies" to identify by David Lee, PhD, of Harvard Univer­ Stephen E. Straus, MD, NCCAM the potential benefits sity as a modified version of another director, stated, "We are excited by the TCM formula, used primarily to treat addition of these cenrers to our research and underlying Bi Syndrome (a syndrome that overlaps program and the unique collaborations and with the Western diagnosis of arthritis approaches they bring to studies of CAM mechanisms of and inflammation) (M. Bahr-Robertson practices. All 5 cenrers will strengthen our CAM practices. e-mail to C. Cavaliere, December 14, research portfolio for major health prob­ 2005). lems-HIY/AIDS, arthritis, asthma, and 2. Center for C hinese Herbal Therapy pain. Plus, the new international centers First-year funding: $1,144,274 will conduct basic and clinical studies 1. Center for Arthritis and Traditional Principal Investigator: Xiu-Min Li, MD of promising CAM inrervenrions drawn Chinese Medicine Institution: Mount Sinai School of Medi­ from traditional medicine indigenous to First-year funding: $1, 197,651 cine, New York, NY the locations of international partners." I Principal Investigator: Brian Berman, MD Center researchers will investigate a According to Chris Thomsen, Institution: University of Maryland, Balti­ 3-herb Chinese formula, known as NCCAM's director of communications, more, MD antiasthma herbal medicine interven­ the funding of these new cenrers also This center will study traditional tion (ASHMI), as a therapy for allergic reflects the recent implementation of NCCAM's 2005-2009 Strategic Plan, "Expanding Horizons of Health Care" Table 1: Chinese Herbs in the HLXL Formula (Huo-Luo-Xiao-Ling Dan) (e-mail, October 16, 2005). The larg­ Chinese (Pinyin) Name Latin Name & Authority* Family est set of goals and objectives in the new plan (available online at www.nccam. Ruxiang Boswellia carterii Birdw. Burseraceae nih.gov/about/plans/2005/) regards the Qianghuo Notopterygium incisum Ting Apiaceae organization's investmenr in research. 2 ex H.T. Chang "These centers and their activities will Danggui Angelica sinensis (Oiiv.) Diels. Apiaceae directly address our goals for interna­ Baishao Paeonia lactiflora Pall. Paeoniaceae tional health research," Thomsen wrote. International Health Research is one of 8 Gancao Glycyrrhiza uralensis Fisch. Fabaceae areas of research explained in the strate­ Yanhusuo Corydalis yanhusuo W.T. Papaveraceae gic plan. Other key areas of the strategic Wang plan include training CAM investigators, Danshen Salvia miltiorrhiza Bge. Lamiaceae expanding outreach, and advancing the organization. Chuanxiong Ligusticum chuanxiong S.H. Apiaceae Qiu US Centers of Excellence for Qinjiao Gentiana macrophylla Pall. Gentianaceae Research on CAM Guizhi Cinnamomum cassia PresI. Lauraceae The 3 new Centers of Excellence provide Duhuo Angelica pubescens Maxim. Apiaceae 5 years of financial support for experienced *The Latin name for Chinese herbs is sometimes based on the presumed genus and species used. It is a frequent researchers at some of the leading universi­ practice in traditional Chinese medicine to substitute another herb for one that is commonly used, the substitute ties in the United States. NCCAM states herb having the same "energetic properties" as the herb for which it is being substituted.

20 I HerbaiGram 71 2006 www.herbalg ram.o rg asthma. The herbs that comprise ASHMI chronic neuropathic pain and pruritis Principal Inves ti gator: Brian Berman, MD are shown in Table 2. The formula {itching). Partner Institutions: University of Mary­ recently demonstrated efficacy in treat­ land, Baltimore, MD; Chinese University ing asthma in a double-blind, placebo­ of Hong Kong, China; University of Illi­ controlled clinical triai.3 Unlike many nois, Chicago, IL; University of Western traditional C hinese herbal formulations Sydney, Sydney, Australia designed for treating symptoms associated This center will conduct multidisci­ with asthma, ASHMI does not contain plinary research on TCM practices ephedra (rn a huang, Ephedra sinica Stapf., (acupuncture and herbal medicine) for Ephedraceae), a well-known and contro­ the treatment of irritable bowel syndrome versial source of ephedrine, which has (IBS). Researchers will study effects of been associated with adverse effects on the acupuncture and a 20-herb TCM prepa­ cardiovascular and central nervous system ration in an animal model of IBS and when used in various dietary supple­ conduct a preliminary study of the herbal ments used for enhanced athletic perfor­ preparation with IBS patients. The herbal mance and weight loss. However, there are formula was developed by Alan Bensous­ few, if any, adverse reports on the safet y san, PhD, of the University of Western of rna huang when it is used in tradi­ Sydney. A clinical trial in 1998 based on tional Chinese herbal formulations used this formula resulted in positive outcomes for respiratory/pulmonary complaints. All in patients with IBS.4 The formula's 3 herbs in ASHMI have a long history contents are shown in Table 3. of use in China, and a body of clinical 2. The International Center for Indig­ evidence tes tifies to their use and safety in enous Phytotherapy Studies: HIV/AIDS, traditional herbal medicine. Studies of the Secondary Infections and Immune herbal formula at the Center for Chinese Modulation H erbal Therapy will look at mechanism Firsr-year funding: $ 1,100,000 of action in an animal model, characteri ze Principal Investigator: William Folk, PhD the herbs' active components, and inves ti­ Bai shao Paeonia /actiflora . Photo ©2006 Partner Institutions: University of stevenfoster.com gate the formula's use in asthma patients. Missouri, Columbia, MO; University 3. Center for Mechanisms Underlying of the Western Cape, Bellville, Republic Millimeter Wave Therapy International Centers for Research on of South Africa; along with University First-year funding: $1,025,895 CAM of KwaZulu-Natal, University of Cape Principal Investigator: Marvin Z iskin, MD The 2 International Centers for Town, and rhe South African Medical Institution: Temple University School of Research on CAM are the outgrowth of Research Council Medicine, Philadelphia, PA planning grams awarded by NCCAM to This center will study the safety and This center will study the mechanisms 11 international teams in 2003. Each of efficacy of traditional African plant-based of action of millimeter wave therapy (use these teams was given 2 years to develop therapies already in wide-spread use for of low-intensity millimeter wavelength a research collaboration and infrastruc­ HIV/AIDS and some of irs secondary electromagnetic waves) for a variety of ture that could compete for 4-year centers infections. Researchers wi ll conduct a small diseases and conditions, as well as look grams. The recipients of these interna­ clinical trial using sutherlandia (Suther­ at the therapy's use in animal models of tional centers grams will now conduct landia frutescens, syn. Lessertia frutescens research on CAM and traditional medi­ (L.) Goldblatt & ].C. Manning, Fabaceae) cine practices in countries where the leaf in adults with HIV and conduct Table 2: Chinese Herbs in the specific practices are indigenous. These preclinical and clinical research wirh Afri­ Antiasthma Herbal Medicine partnerships between researchers in the can wormwood (Artemisia afra Jacq. ex. Intervention (ASHMI) Formula United States and foreign institutions wi ll Willd., Asteraceae) aerial parts, which are Chinese Latin Name Family address whether the traditional practices used by traditional healers for treatment (Pinyin) &Authority can aid in health care locally and globally of many conditions seen in people with Name and build CAM research capacity inter­ HIV/AIDS. Ling-zhi Ganoderma Ganoder- nationally. Co-funders for these centers In addition, the National Cancer Insti­ /ucidum mataceae include NIH's Office of Dietary Supple­ tute (NCI) will fund a third international (Curtiss:Fr) ments, Office of AIDS Research, and center: P. Karst Fogarty International Center (the Interna­ International Center of Tradi­ Ku-shen Sophora Fabaceae tional division of NIH ). tional Chinese Medicine for Cancer flavescens The 2 NCCAM recipients are described Principal Investigator: Lorenzo Cohen, Aiton below. PhD Partner Institutions: M.D. Ander­ Gancao Glycyrrhiza Fabaceae 1. Functional Bowel Disorders in son Cancer Center, Houston, TX; Fudan uralensis Chinese Medicine University Cancer Hospital, Shanghai, Fisch ex. DC. First-year funding: $807,253 C hina www.herbalgram.org 2006 HerbaiGram 71 I 21 ------~ Research &World News t------

This center will conduct preclinical technology, population studies, and prog­ and tolerability of antiasthma herbal and clinical studies of 3 TCM approaches nostic markers."5 HG medicine intervention in adult patients (herbs, acupuncture, and qi gong) for -Mark Blumenthal with moderate-severe allergic asthma. j Allergy Clin lmmunol. 2005; 116:3:517- treating cancer and its symptoms, as and Courtney Cavaliere 524. well as treatment-related side effects. References 4. Bensoussan A, Talley N, Hing M, 'The collaboration we have with Fudan Menzies R, Guo A, Ngu M. Treatment University Cancer Hospital is mutually 1. NCCAM Expands Research Centers of irritable bowel syndrome with Chinese advantageous [and] ultimately we believe Program with Three Centers of Excel­ herbal medicine. j Amer Med Assn. 1998; that together we can make an impact on lence and Two International Centers 280(18): 1585-1589. cancer patients worldwide," said Lorenzo [press release]. National Centers for 5. M.D. Anderson and Shanghai Hospital Complementary and Alternative Medi­ Cohen, PhD, principal investigator of awarded NCI grant to study traditional cine, October 14, 2005. Available at: the center and director of the Integra­ Chinese medicine in cancer cure [press http:// nccam.nih.gov/ news/2005/1 01405. release] . Houston, TX: MD Anderson tive Medicine Program at M.D. Ander­ htm. Accessed October 23, 2005. Cancer Center, November 21, 2005. son. "Traditional Chinese medicine has 2. Expanding Horizons of Health Care: a remarkable history and by applying Strategic Plan 2005-2009. National western research standards to traditional Centers for Complementary and Alterna­ Chinese medicine, we can better under­ tive Medicine. Available at http://www. stand possible new applications. Likewise, nccam .nih.gov/about/plans/2005/. our collaborators in China are learning a Accessed October 31, 2005. great deal about the structure and design 3. Wen M, Wei C, Hu, Z, Srivastava K, Ko of clinical trials, new diagnostic imaging J, XiS, Mu 0, Du J, Li G, Wallenstein S, Sampson H, Kanan M, Li X. Efficacy

Table 3: Chinese Herbs in Formula for Treatment of IBS* Chinese (Pinyin) Name Latin Name & Authorityt Family Dangshen Codonopsis pilosula (Franch.) Nannf. Campanulaceae Huoxiang Agastache rugosa (Fisch. & C.A. Mey.) Kuntze Lamiaceae Pogostemon cab/in (Blanco) Benth.* Lamiaceae

Fangfeng Ledebouriella sese/aides (Hoffm.) H. Wolff. Apiaceae Yiyiren Coix lacryma-jobi L. Poaceae Chaihu Bupleurum chinense DC. Apiaceae Yinchen Artemisia capillaris Thunb. Asteraceae Baizhu Atractylodes macrocephala Koidz. Asteraceae Houpo Magnolia officina/is Rehder & E.H. Wilson Magnoliaceae Chen pi Citrus reticu/ata Blanco Rutaceae

Paojiang Zingiber officinale Roscoe Zingiberaceae Qinpi Fraxinus chinensis Rox b. Oleaceae Fuling Poria cocos F.A. Wolf Polyporaceae Baizhi Angelica dahurica (Fisch. Ex Hoffm.) Be nth. & Apiaceae Hook. F. ex Franch. & Sav. Cheqianzi Plantago asiatica L. Plantaginaceae Huangbai Phellodendron spp. Rupr. Rutaceae Zhigancao G/ycyrrhiza uralensis Fisch. Ex DC. Fabaceae

Baishao Paeonia lactif/ora Pall. Paeoniaceae

Muxiang Saussurea spp. DC. Asteraceae Huang/ian Coptis chinensis Franch. Ranunculaceae Wuweizi Schisandra chinensis Michaux Schisandraceae *The list of herbs in this formulation is based on those used in a formula tested in a clinical trial for IBS 4 t The Latin name for Chinese herbs is sometimes based on the presumed genus and species used. It is a frequent practice in traditional Chinese medicine to substitute another herb for one that is commonly used, the substitute herb having the sa me "energetic properties" as the herb for which it is bei ng substituted. *The Chinese herb huo xiang has often been noted as being derived from the genus Agastache; however, recently it has also been derived from the genus Pogostemon (5. Dhar- mananda e-mail to C. Cavaliere, March 16, 2006).

22 I HerbaiGram 71 2006 www.herbalgram.org Global Horticulture Initiative to Improve Health and Economies of Developing Countries by Courtney Cavaliere

international network of agricultural and nutrition research organizations and experts launched the Global Horticul­ ure Initiative (GHI) in March of 2006.1 This initiative is intended to mobilize research and development of resources for A he improvement of horticulture in developing countries, allowing inhabitants to grow fruits and vegetables for domestic consumption and to export in an environmentally sustainable manner.

Over 74 participants from 23 countries in malnutrition and lowered resistance to developing countries [press release] . Shan­ have joined the initiative, which was co­ diseases, which are endemic within many hua, Taiwan: Global Horticulture In itia­ organized by the following: AVRDC­ developing countries. tive; March 29, 2006. The World Vegetable Center, the Inter­ Further information regarding the GHI 2. Proj ect Proposal: The Global Horticulture Initiative. Global Horticulture Initiative national Cemer for Cooperation in Agro­ and its goals are ava ilable at the Web site Web sire. Available at: hrrp://www.global­ nomic Research for Developmem (Cemre www.globalhort.org. HG horr.org/pdf/ghi_proposal. pd f. Accessed: de Cooperation Imernationale en Recher­ April 17, 2006. che Agronomique pour le Developpement, References CIRAD), and the International Society I. Joint efforts that will improve the liveli­ for Horticultural Sciences (ISHS). The hoods of millions in Africa and other main goals of the initiative are to foster economic growth and improve health and nutrition within developing countries. The GHI will initiate output-oriented research and development projects designed to improve production and marketing of horticulture in certain countries, and it will promote the formulation of poli­ cies and programs that support small­ scale farmers and horticultural commerce both domestically and worldwide.2 Such efforts will focus primarily on sub-Saha­ ran Africa and South Asia, with secondary emphasis in Central Asia, Southeast Asia, and Latin America. Over $2.5 million has already been raised to fund the initiative's activities and projects. 1 The GHI is further seeking $5 million per year for base funding over a 5-year period.2 Various funding agencies will be enlisted to sustain and increase the GHI. The horticultural systems proposed by the GHI are expected to generate higher incomes for farmers and those work­ ing within food processing industries. Women, in particular, are expected to benefit from these projects, for they often comprise the dominant workforce of horti­ cultural production and related indus­ tries. The GHI has expressed its commit­ ment to empowering such female work­ ers. Resource-poor households outside the production sector, meanwhile, will benefit through improved access to affordable vegetables and fruits, which should provide nutrients often lacking in inhabitants' diets. Inadequate diet frequently results

www.herbalgram.org 2006 HerbaiGram 71 I 23 Gum Arabic Industry Members Commit to Sustainability by Katherine Purcell and Nancy Dennis

nternational members of the gum Arabic industry have reached a consensus on future development and trade of the lucrative tree resin,1 which is used as an emulsifying agent in many commercial products.2 The resin is derived from the gum Arabic tree I (Acacia senegal [L.] Willd., Fabaceae). Gum Arabic industry representatives from Chad, Nigeria, Sudan, the Association for the International Promotion of Gums (AIPG), Food and Agricultural Organization of the United Nations (FAO), Network for Natu­ ral Gums and Resins in Africa (NGARA), and the World Bank met on June 8, 2005, in Khartoum, Sudan, and committed to work together to promote and preserve this natural resource)

Industry members ex plored ways to to build up "a security stock amount­ maintain the gum supply at fair prices ing to one yea r's crop quantity in each of for the international marker. "This mee t­ the main three exporting countries."4 In ing will be remembered as historic if the an effort to help with the environmental participants make good on their prom­ and socio-economic impact of producing ises to do the necessa ry and doable ro put gum Arabic, the industry members agreed gum Arabic business and public relations that gum farmers should be encouraged on a stronger footing," said Paul Flower­ ro maintain and increase their supply of man, president of P.L. Thomas (PLT), the product by assuring them a reaso nable a Morristown, NJ-based importer and profit and a continuous market.3 supplier of gum Arabic and other natural Flowerman explained that chang­ ingredients.' ing conditions have affected gum Arabic Industry members agreed that world­ supplies: wide consumption of gum Arabic could The recent peace treaty between the potentially increase and that the future Khartoum government (the national development of gum Arabic depends on Sudan regime) and the Sudan People's product availability, clear communication Liberation Army {representing the South­ on current and future market conditions, ern Sudan resistance) has ended north­ quality standards, information-sharing so uth hostilities and finally opened up among gum distributors and suppliers, important stands of gum Arabic trees for and reasonable prices.3 tapping and collection. This additional

"I am confident that we are going the crop should make up for declines in the Anm Sntt ll Wi.lli right way in joining forces to create cred­ traditional producing regions , where old ibility and trust among gum Arabic users, trees, decreasing village populations, and while securing all stages of the supply what is called 'oil fever' are reducing chain, from the Acacia tree to the process­ the size of the collections. Further, the Illustration of Acacia se negal (gum Arabic) from ing unit of the worldwide industry," said displacement of nearly 2 million Darfur Kohler's Medizinai-Pflanzen in naturgetreuen Abbil­ Hinrich Wolff, president of the AIPG, inhabitants has virtually eliminated that dungen mit kurz erlauterndem Texte: Atlas zur in a press release statement about the state as a source of supplies. Darfur previ­ Pha rmacopoea germanica, by Kohler, F. E. (Franz Khartoum meeting. Participants agreed ously accounted for about 5% of total Eugen) Volume 2 of 3 © 1995-2004 Missouri Botani­ ca l Garden (http://ridgwaydb.mobot.org/mobot/ rare books!)

supplies (P. Flowerman, e-mail, August Correction 22, 2005). According to Flowerman, industry An article in Herba!Gram 70, "Preserving Ayurvedic Herbal Formulations participants from the 3 major African by Vaidyas" by Chandra Prakash Kala, contains 3 errors: (1) the human popu­ producing countries held a follow-up lation of Uttaranchal, India, is about 8.5 million, not 805 million as stated meeting on October 3-4, 2005, in Ndja­ {a typographical error converted the period to a zero); {2) according to the mena, Chad, and another on March 9-10, World Health Organiza tion {2003), the global market for herbal medicines is 2006, in Nigeria to discuss implementa­ over $60 billion annually, not $120 billion as stated in the article, and {3) the tion of the plans agreed to in previous article incorrectly states that medicinal plants used in Ayurvedic preparations meetings (P. Flowerman, e-mail, March represent $60 billion in annual sales ; while definitive statistics to measure this 9, 2006). At the October meeting, partic­ market are somewhat elusive, some estimates range from $550 million to $1 ipants agreed ro a proposal by AIPG billion (USD). The American Botanical Council regrets these errors and apolo­ to create a task-force of representatives gizes for any inconvenience they may have caused. from C had, Nigeria, Sudan, AIPG, and NGARA (P. Flowerman, e-mail, March

24 I HerbaiGram 71 2006 www.herbalgram.org 2, 2006). The world's largest producers of "gum Arabic" does not imply a particular Association for International Promotion gum Arabic are Sudan, Chad, and Nige­ botanical source. 8 of Gums; June 7-8, 2005. Available at: ria, producing respectively 25,000 metric For more information on gum Arabic, hrrp:/ /www. rreegums.org/ documenrs/ tons (MT), 10,000 MT, and 3,000 to irs uses, and the political problems AI PG%20 Press%20 Release%20 English. pdf. Accessed August I 0, 2005. 5,000 MT annually.5 impacting irs production, please refer 5. Panos L. New gum Arabic strategy to In January 2006, the BBC reported to the HerbalGram article, Sudan War nurture buffer stocks for price stabil­ that "millions of Sudanese still live in fe ar Impacts Avai lability of Gum Arabic, A ity. June 17, 2005. Food Navigator of violence, a year after the peace deal Key Ingredient for Many Commercial Web sire. Europe. Available at: http:// ended 21 years of war between north and Products.2 HG www.foodnavigaror.com/news/news­ south."6 Meanwhile conflict in the west­ ng.asp?id=G0729-new-gum-arabic. ern province of Darfur continues. Never­ References Accessed August 10, 2005. theless, 500,000 southern Sudanese are I . International gum Arabic industry and G. BBC News. "'Little Cheer' from Sudan peace." January 200G. Available at: http:/ I expected to return home this year, 6 and major NCO's affirm commitment to news.bbc.co. uk/2/hi/ africa/ 4 59424 2.stm. a February 2006 FAO Special Report on sustain and expand gum Arabic supplies and availability [press release]. Morris­ Accessed March I G, 200G. Sudan stated that "increased security and town, NJ: PL Thomas & Co., lnc.; June 7. FAO Corporate Document Reposi ­ favorable prices" has led to "an upsurge in 8, 2005. Available at: hrrp://www.plrho­ tory. Special Report on Sudan. Febru­ the collection of gum Arabic."7 mas.com/presso/o20releaseo/o20gum o/o 20ar ary 200G. Available at: hrrp://www.fao. Gum Arabic is also called acacia, acacia abic.pdf. Accessed August 3, 2005. org/documenr s/show_c dr.asp? url_ file= l gum, or Senegal gum. Materials sold as 2. Purcell K. Sudan war impacts availabil­ docrep/008/j7072e/j7072eOO.HTM. gum Arabic are derived from the resin of ity of gum Arabic, a key ingredient for Accessed March 17, 200G. 8. Food and Agriculture Organization of the several species of acacia trees. According many commercial products. Herba!Gram. Un ited Nations. Non-wood forest proj­ to the FAO, the term gum Arabic is used 2005;No. G5:25-27. 3. Khartoum declaration on gum Arabic ects G. Exudate Gums. FAO Web si te. differently by different groups of people. security stock. June 8, 2005. PL Thomas Avai lable ar: http://www.fao.org/docu­ For example, in Sudan the name gum Web site. Available at: hrrp://www.plrho­ menrs/s how_cdr.asp?url_file=/docrep/ Arabic represents two different types of mas.com/ khartoumo/o20declarationo/o 20o Y923GE/V923GEOO.hrm. Accessed April gum which are produced and marketed n o/o2 0gum o/o20a rabico/o20securi tyo/o 20sto 18 , 200G. similarly but are traded differently. These ck.pdf. Accessed August 3, 2005. include hashad, from A. senegal, and talha, 4. AIPG. International gum Arabic industry from A. seyal. The FAO clarified that and major NCO's affirm commitment to most internationally traded gum Arabic sustain and expand gum Arabic availabil­ ity [press release]. Hamburg, Germany: comes from A. senegal, but that the term

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www.herbalgram.org 2006 HerbalGram 71 I 25 Research Reviews

Trial Suggests Saffron's Potential to Treat Mild to Moderate Depression viewed: Akhondzadeh S, Tahmacebi-Pour N, Noorbala A, et al. Crocus sativus L. in the treatment of mild to moderate depres­ ltion: a double-blind, randomized and placebo-controlled trial. Phytother Res. 2005;19(2):148-151. The dried stigmas of saffron (Crocus magnesium stearate as "lubricant" (used between the saffron and placebo groups sativus L., lridaceae) flowers are highly as a flowing agent in the manufacturing was not significant (P = 0.18-1.39). valued and the most expensive spice process), and sodium starch glycolate as a Although this clinical trial was rela­ worldwide. In Persian traditional medi­ disintegrant. The extracts were not chemi­ tively short (6 weeks) and the saffron cine, saffron is used as an antispasmodic, cally standardized to a particular chemical extract was not chemically standardized, an appetite stimulant, and as a treatment marker. Subjects were randomized at a I: I this trial demonstrates the potential of for depression. Many healrhcare consum­ ratio (i.e., 20 subjects in each group) to saffron as a treatment for mild to moder­ ers are turning to alternative therapies for receive either 30 mg per day of the saffron ate depression, consistent with some of the treatment of minor to moderate cases extract or a placebo for 6 weeks. its traditional use in Persian traditional of depression as concerns over the adverse Out of 40 subjects, 35 completed the medicine. In addition, the results of this effects and safety of conventional pharma­ trial. Although the number of dropouts trial also demonstrate a relatively rapid ceutical antidepressants have grown. was small (1 saffron group and 4 placebo onset of antidepressant action and lower This relatively small (n = 40) random­ group), no significant difference was incidence of side effects of saffron capsules ized, double-blind, placebo-controlled trial, conducted in the Roozbeh Psychiat­ ric Hospital in Tehran, Iran, was designed to evaluate the efficacy of a proprietary extract of saffron stigmas in the treatment of mild to moderate depression as defined by the fourth edition of the Diagnostic and Statistical Manual ofMental Disorders (DSM-IY).l The trial covered a relatively short period of 6 weeks. All subjects had a baseline Hamilton depression rating of at least 18 and were between the ages of 18- 55. Patients taking psychotropic medica­ tion or patients with diagnoses of schizo­ phrenia, bipolar disorder (current or past), or schizotypal personality disorder and patients in danger of committing suicide were excluded from the trial. Saffron stigmas (Novin Zaferan Co., Mashhad, Iran) were extracted by percola­ tion in 80% ethanol, and the dried extract (15 mg) was made into capsules of 15 mg Saffron Crocus sativus Photo ©2006 stevenfoster.com extract compounded with !acrose as filler,

observed between the placebo and saffron when compared to conventional pharma­ group drop-out rates (P = 0.34). There was ceutical antidepressants. Notably, at the also no significant difference between the fixed dose of saffron used in this study, no Correction Hamilton depression scale ratings of the 2 abnormal bleeding was observed, one of The following article in groups at baseline (P = 0.73). However, at the notable reported side effects of saffron. Herba!Gram 70 (page 52) contains week 6, the change in Hamilton depres­ Determination of the active constituent or an error: "Government Increases sion rating scores compared with baseline constituents responsible for this activity Restrictions on Wild American scores was significantly different between and a larger clinical trial using standard­ Ginseng Export." Patricia Ford, the 2 groups (P < 0.0001). At the end point ized extracts are needed to va lidate these a botanist with the US Fish and (week 6), the mean Hamilton depression results. HG Wildlife Service, was incorrectly rating scores had decreased by -12.20 ± - Marissa Oppel, MS referred to as a "wildlife biologist." 4.67 for the saffron group and -5.10 ± 4.71 The American Botanical Council for the placebo group when compared Reference regrets this error and apologizes with baseline scores. Adverse side effects 1. Diagnostic and Statistical Manual of for any inconvenience this may noted were anxiety, decreased appetite, Mental Disorders. 4th ed. American have caused. increased appetite, sedation, nausea, head­ Psychiatric Association: Washington, DC; 1994. ache, and hypomania. However the differ­ ence in frequency and rate of side effects

26 I HerbaiGram 71 2006 www.herbalgram.org Research Reviews

Andrographis, Asian Ginseng, and Valerian Extracts Tested in Small Trial on Male Fertility viewed: Mkrtchyan A, Panosyan V, Panossian A, Wikman G, Wagner H. A phase I clinical study of Andrographis anic~la~a fixed combination Kan Jang versus ginseng and valerian on the semen quality of healthy male subjects. Phytomed. 005,12.403-409.

Extracts from the leaves of andrographis ginsenosides. Group 5 (n=5) received 5 and comparisons within the groups we re (Andrographis paniculata [Burm. f.] Nees, tablets/day of a valerian extract (Fi nzel­ carried out with paired t-tests and one-way Acanthaceae) are becoming more popu­ berg GmbH, Andernach, Germany) stan­ ANNOVA tests. lar in the United States as an increasing dardized to 0.43% va lerenic acid. The The study medications were well toler­ amount of published research strongly duration of the study was 13 days; the ated and the subjects reported no adverse supports the benefits of this traditional study medications were administered for events resulting from the study medica­ Chinese and Ayurvedic herb for treat­ 10 days. Semen analysis was conducted tions. No significant changes in the testi­ ing symptoms of upper respiratory tract throughout the study and a global assess­ cles of the subjects were observed. The infections, usually secondary to colds and ment of the subjects' hea lth was carried study medications did not reduce male flu. 1 This trial attempts to study the safety our on day 13. fertility parameters in any of the subjects of andrographis in a fixed combi­ in the study. The authors found nation extract (Kan Jang~, Swed­ no significant differences in male ish Herbal Institute, Gothenburg, fertility parameters between the Sweden) on male fertility compared Kan Jang groups and the valerian to 2 commonly used herbs: Asian and ginseng groups. The authors ginseng (Panax ginseng C.A. Meyer, conclude that Kan Jang is safe with Araliaceae) and valerian root (Vale­ regards to male fertility parameters riana officina/is L., Valerianaceae). at doses of up to 3 times the recom­ Kan Jang is a fixed combina­ mended daily dose for 10 days. tion of andrographis leaf special In addition, Asian ginseng and extract SHA-10 and eleuthero valerian show no negative effects (Eieutherococcus senticosus [Rupr. on male fertility when administered & Maxim.] Maxim., Araliaceae) at 3 times the recommended daily special extract SHE-3 employed in dose for a duration of 10 days. the treatment of various conditions The authors note a positive trend associated with the common cold. in the number of spermatozoids in The authors conducted an open the whole ejaculate, an increase in randomized parallel study (Repub­ the percentage of active forms of lican Medical Centre of Dermatol­ spermatozoids, a decrease in the ogy and Diseases Disseminated by percentage of inactive (diskinetic) Sexual Contacts; Yerevan, Armenia) forms of spermatozoids, and an designed to ascertain the effects of increase in the Farris fertility indi­ valerian root and Asian ginseng on ces of the subj ects receiving Kan parameters of male fertility. Jang. A decrease in the percent­ The study subjects were healthy age of diskinetic forms of sper­ males , aged 18-35, with normal matozoids was observed for both semen quality. Subjects were divided Asian ginseng and valerian treat­ into five groups. Group 1 (n=5) Andrographis Andrographis paniculata. Photo© 2006 Swedish ments; while, in addition, a tempo- received Kan Jang mixture I stan­ Herbal institute. rary increase in the percentage of dardized for 10.0 mg/ml androgra­ normokinetic spermatozoids was pholide at the daily therapeutic dose noted for valerian. However, this is of 6ml!day. Group 2 (n=5) received 6ml/ The male fertility parameters measured a phase I clinical study, involving a small day of Kan Jang mixture II, standardized included the Farris Fertility index, vo lume number of subjects. Future studies are to 20 mg/ml andrographolide, equiva­ of ejaculate, number of spermatozoids in 1 necessary to confirm these results. HG lent to double the daily therapeutic dose. ml of ejaculate, total number of spermato­ -Marissa Oppel, MS Group 3 (n=6) received 9ml/day of Kan zoids in whole ejaculate, and percentage of Jang mixture II, equivalent to triple the active (normokinetic; i.e., normal move­ Reference daily therapeutic dose. Group 4 (n=5) ment) spermatazoids. Statistical compari­ 1. Coon JT, Ernst E. Andrographis received 40 ml!day of Asian ginseng root sons at 95% confidence intervals were paniculata in the treatment of upper extract (Finzelberg GmbH, Andernach, carried out between study groups using respiratory traer infections: a systematic review of safety and efficacy. Planta Med. Germany) standardized to 10.5% total unpaired t-tests and Mann-Whitney tests, 2004;70(4):293-298.

www.herbalgram.org 2006 HerbaiGram 71 I 27 Research Reviews

Trial Suggests Efficacy of Pomegranate Juice on Myocardial Perfusion D eviewed: Sumner MD, Elliott-Eller M , Weidner G, eta!. Effects of pomegranate juice consumption on myocardial perfusion in .l.~ atients with coronary heart disease. Am] Cardiol. 2005;96:810-814.

Pomegranate (Punica granatum L. , Purchase, NY) with added corn syrup rions or revascularizarion in either group. Punicaceae) juice is a rich source of anti­ to make ir isocaloric with the pome­ No significant changes in body weight, ox idants, such as soluble polyphenols, granate juice. The placebo was tested blood press ure, or plasma lipid, glucose, tannins, and anthocya nins, and it may in an independent laboratory for poly­ or hemoglobin Ale concentrations were have anriarherosclerotic properties. Animal phenols, and it was determined that it observed throughout the study. Episodes studies have shown that dietary supple­ contained none.) Blood press ure and lipid, of angina decreased by 50% (from 0.26 mentation with polyphenolic antioxidants glucose, and hemoglobin Ale concen­ to 0.13) in the pomegranate group but inhibits the oxidation of low-density lipo­ trations were measured at baseline and increased by 38% (from 0.53 to 0.75) in protein (LDL, rhe "bad" choles terol) and at 3 months. Additionally, the subjects the placebo group, though this difference macrophage foam cell formation, and underwent myocardial perfusion imag­ was nor statistically significant. thus retards the development of athero­ ing at rest and under stress with the use The results suggest, for the first time, sclerosis (the accumulation "rhat daily consumption of plaque on arterial walls, of pomegranate juice for 3 which can increase rhe risk months may decrease myocar­ of ca rdiovascular problems d ial ischemia and improve such as heart attack, stroke, myocardial perfu sion in etc.). H owever, the effects of patients who have ischemic pomegranate juice in patients CHD as measured by the with ischemic coronary heart SDS." The clinical signifi­ disease (CHD) have not been cance of rhis finding was investigated. (CHD is char­ supported by rhe average acterized by reduced blood improvement in myocar­ supply from blocked coronary dial perfusion of 17% in the arteri es, typically caused by pomegranate group and the atherosclerosis.) The objective average worsening in myocar­ of this study was to eva lu­ dial perfusion of 18o/o in the ate rhe effects of pomegranate placebo group. These find­ juice on myocardial perfusion ings are consistent with the (a test that uses low doses beneficial effects of poly­ of radioactive agents to eval­ phenol-containing bever- uate the heart's blood flow Pomegranate Punica granatum Photo ©2006 stevenfoster.com ages observed by other inves­ and function) in patients wirh tigators. In a recent study C HD. conducted by de Nigris et al, 1 Forty-five patients (age range: 69 ± 10) of single-isotope (rechnerium-99m rerro­ oral administration of pomegranate juice with stable CHD were enroll ed in this fosmin) si ngle-photon emiss ion computed to mice at various stages of hypercholes ter­ randomized, placebo-controlled, double­ tomography at baseline and at 3 months. olemia reduced rhe progress ion of athero­ blind study conducted by researchers Technetium uptake was measured in 17 sclerosis significantly. The authors of the at the University of California at San myocardial segments per subject with a current study recommend that additional Francisco (UCSF), the California Pacific semiquantitative 5-point scoring method, studies be conducted to determine rhe Medical Center (Sa n Francisco, CA), and where 0 = normal uptake and 4 = absent effects of pomegranate juice in a larger rhe Preventative Medicine Research Insti­ uptake. A summed difference score (SDS), sa mple size and over a longer peri od of tute (PMRI, Sausalito, CA). All patients indicating the difference in blood flow time. HG were confirmed to have stress-induced under resting and stressed conditions was -Brenda Milot, ELS ischemia evidenced by at least one revers­ derived to indicate the level of inducible ible myocardial perfusion. The patients myocardial ischemia. Reference were randomly assigned to receive either Inducible ischemia, determined on the 1. de Nigr is F, Willi ams- lgnarro S, Lerman 240 mL!day (8 oz) of pomegranate juice basis of SDSs, was nor significantly differ­ LO, et al. Beneficial effects of pomegran­ (POM Wonderful, Los Angeles, CA) or ent between rhe pomegranate and placebo ate juice on oxi dation-sensi tive genes and endothelial nitric oxide synthase a modified sports beve rage similar to the groups at baseline; however, it decreased activity at sites of perturbed shea r stress. pomegranate juice in tas te, color, and in the pomegranate group (by 0.8 plus/ Proc Na t! Acad Sci [serial onlin e] . caloric content (placebo) for 3 months. minus 2.7) and increased in the placebo 2005; 102(12):4217---4655 . Avai lable (The placebo did nor contain any juice or group (by 1.2 plus/minus 3. 1) at 3 months at: www. pnas.org/ cgi/ content/ abstract/ fruit or bioacrive compounds. Ir contained (P < 0.05). This benefit was observed with 05009981 02v I. Accessed September 22, several fl avors of Gatorade" [PepsiCo, no significant changes in cardiac medica- 2005.

28 I HerbaiGram 71 2006 www.herbalgram.org Research Reviews

ABC Clarifies Recent Meta-analysis of Milk Thistle Clinical Trials viewed: Rambaldi A, Jacobs BP, Iaquinto G, Gluud C. Milk Thistle for alcoholic and/or hepatitis B or C diseases-A ystematic Cochrane hepato-biliary group review w ith meta-analyses of randomized clinical trials. Am J Gastroenterol. 005;100:2583-2591.

In ea rly January 2006 the American selling herbal dietary supplement in main­ clinical and pharmacological literature on Botanical Council (A BC) received numer­ stream retail markers. 2) MTE. ous requests from members for a response ABC and some of irs scientific ro a recently-published meta-analys is of colleagues and medical advisors reviewed Safety Obfuscated milk thistle clinical trials. This popu­ the meta-analysis and found anomalies A press release from Blackwell Publish­ lar herbal dietary supplement, the study in its contents. ABC also noted that there ing,-' publisher of the American journal concluded, is ineffective for various disor­ are discrepancies in the published analy­ of Gastroenterology, resulted in a shorr ders of the liver. ABC iss ued a Media Alert sis and the publicity from the journal's Reuters' news report4 and other brief arti­ to select Sponsor Members, the contents publisher. cles on va rious Web sites, although ro dare of which are contained in this arricle. 1 First, ABC emphasized that the rhis article does nor appear ro have been T he meta-a nalysis of 13 clinical trials (II published meta-a nalysis concluded that reported in other major media. published and 2 conference abstracts) on MTE is safe and was well tolerated in Despite numerous positive statements the concentrated and standardized extract the clinical trials of va ri ous durations. made by rhe authors in rhe ori ginal paper of milk thistle seed (Sifybum marianum Second, the ABC review determined that about the safety and efficacy of MTE, [L.] Gaerrn., Asteraceae) was published the conclusion questioning MTE's effi­ the press release from Blackwell Publish­ D ecember 2005 in the American journal cacy is based primarily on rhe results ers focuses primarily on rhe negative. The of Gastroenterology. Milk thistle extract of only one of the 13 trials reviewed by press release quotes Dr. C hristian Gluud (MTE) is a popular herbal dietary supple­ the paper's authors. Ar least 2 of the 4 of the Copenhagen Trial Unit, Cenrer ment in the United States, used primar­ authors have previously conducted system­ for C linical I merve mion Research at rhe ily for its reputed beneficial effect on the atic reviews of rhe li terature on MTE; Copenhagen University H os pital, one of liver. (In 2004 MTE was the lOth largest- thus they appear quite familiar with the the study's authors, as say ing, "The ironic

www.herbalgram.org 2006 HerbaiGram 71 I 29 Research Reviews

fact is rhar even though milk thistle and average length of treatment for the pooled this set of trials, and, in fact, the main milk thistle extracts have been widely studies) and which generally requires stud­ negative conclusion ends up resting on the examined, we are still nor in a situation ies with a large number of subjects to show results of one trial. A second trial, which is where we can exclude a potential benefi­ a difference. smaller, older and of somewhat less qual­ cial or harmful effect." There were only enough trials to make ity, shows a benefit for MTE. Further, Dr. Gluud's equivocation about the a comment in alcoholic liver disease (e.g., including all trials again shows a benefit safety ofMTE in the press release is directly "Liver-related mortality was significantly for the more specific outcome, mortality at odds with the results of the paper itself reduced [emphasis added] by MT in ALL related to liver disease. Also, the average where several statements regarding the trials."). Dr. Hardy notes that "almost all duration of treatment is short for a mortal­ lack of adverse effects of MTE are made. of rhe deaths occur in only two studies. ity trial. Therefore, the authors' conclu­ For example, the authors of the meta-anal­ We don't have adequate details about rhe sion about the efficacy of MTE needs to ys is write, " ... among the randomized clin­ patients in these trials to comment about be viewed with qualifications." It should ical trials reporting adverse drug events, why so many deaths were reported here be noted that the quality of some of the MT appeared safe and well tolerated." (were the patients more severely ill, still studies is relatively poor and additional Commenting on the meta-analysis, ABC drinking, ere.?)." studies, especially in the area of viral hepa­ Advisory Board member Mary Hardy, Dr. Hardy added, "The more specific titis, may be warranted. MD, rhe former associate director of the UCLA Center for Human Nutrition, stared, "This meta-analysis did nor show that MTE had significant adverse events, nor did it increase all-cause mortality in rhe majority of trials." [M. Hardy e-mail to M. Blumenthal, January 6, 2006.] Using authoritative reviewers, ABC previously published an extensive Safety Assess ment Report on MT.5 This report found what most other authoritative reviewers have concluded: rhe safety of MTE is well established in exten­ sive animal resting and human clinical trials, as well as a significant level of use in Germany and other parts of Europe where adverse events, if they occur, would have been reported to health authori­ ties as part of the normal practice of pharmacovigilance for nonprescription medications. (ABC Sponsor Members and others are invited to contact ABC Milk Th istle Silybum marianum Photo ©2006 stevenfoster.com for information about licensing the MT Safety Assessment Report for labeling or use as educational content on Web sires.) outcome, death related to liver disease, Other Considerations about Milk reportedly shows that MTE is protec­ Thistle Efficacy Questions tive if all trials are taken into account. MT has a long history of safe use in "The methodology employed in this The conclusion that this meta-analysis traditional folk medicine as an herbal meta-analysis is sound," noted Dr. Hardy, arrives ar-'based on high quality trials, remedy for the liver. There are an impres­ "bur, like all meta-analyses, it is limited MT does nor seem to significantly influ­ sive number of experimental and animal by the material in the review. The medica l ence the course of patients with Alcoholic pharmacology research studies, plus the conditions examined are widely varied­ and/or Hepatitis B or C liver disease'-is body of clinical trial data, that suggest everything from alcoholic liver disease therefore based on ONE article. Many of a positive benefit of MTE on liver func­ (primarily what appears to be end-stage these patients also had Hepatitis C ami­ tion. The totality of all this evidence cirrhosis) to steatosis (accumulation of bodies and may have been sicker." suggests the efficacy of MTE for various fatty tissue in an organ) to viral disease Dr. Hardy also noted rhar the method­ applications related ro liver function. For (both Hepatitis B and C). These diseases ological quality of the trials reviewed were example, the ABC Clinical Guide to Herbs have different etiologies [sources] and lots fair, especially since many of these were reviews 21 clinical trials, most of which of confounding variables, such as whether relatively older trials. She summarized her show some positive results for liver-related or not patients stop drinking alcohol." thoughts on this meta-analysis as follows: disorders. 6 In addition, rhe German The primary outcome measured was "The meta-analysis employs a good government's Commission E reviewed the all-cause mortality-a difficult variable methodology, bur the primary outcome available literature on MT and concluded to rest in trials as short as 6 months (the variable would be difficult to assess with that it is safe and effective for "roxie liver

30 I HerbaiGram 71 2006 www.herbalgram .org Research Reviews

damage and for supportive [i.e., adjunct, derance of scientific and medical evidence, schlaeger B, eds. The ABC Clinical Guide not primary] treatment in chronic inflam­ it is the view of ABC and its advisors to Herbs. Austin, TX: American Botanical matory liver disease and hepatic cirrho­ that some of the conclusions of the meta­ Council; 2003. sis."? Additional therapeutic monographs analysis are flawed and have been misin­ 7. Blumenthal M, Goldberg A, Brinck­ mann J, eds. Herbal Medicine: Expanded have been published by the World H ealth terpreted and misreported in subsequent Commission E Monographs. Austin , TX: Organization, 8 recognizing the therapeu­ media reports. HG American Botanical Council; Newton, tic value of MTE. -Mark Blumenthal MA: Integrative Medicine Communicati­ The bulk of scientific evidence shows ons; 2000. that MTE concentrated extract is safely References 8. Fructus Si lybi Mari ae. World H ealth tolerated in both animals and humans, I. Blumenthal M . ABC Clarifies Recent Organization Monographs on Selected MTE has demonstrated strong antioxidant Meta-analysis of Milk Thistl e C linical Medicinal Plants. Volume 2. Geneva: WHO; 2002. effects, and MTE increases RNA synthe­ Trials. Media Alert. Austin, TX: Ameri­ can Botanical Council; January II, 2006. 9. Mills E, Wilson K, C larke M, et al. sis in helping to create new hepatocytes, 2. Blumenthal M. H erb sales down 7.4 Milk thistle and indinavir: a randomized i.e., helping to rebuild the liver tiss ue.6,7 percent in mainstream marker: garlic is controlled pharmacokinetics study and In fact, the authors of the meta-analysis top-sell ing herb; herb combinations see meta-analysis. Eur j Clin Pharmacol. write, " .. .we found that MT significantly increase. HerbalGram. 2005; No. 66:63. 2005;6 1:1-7. improved two liver biochemical variables, 3. Common Alternative Treatment for Liver I 0. DiCenzo R, Shelton M, Jordan K, et al. s-bilirubin and GGT." Disease is Found to be Ineffective [press Co-admin istration of milk thistle and Further, several recent clinical trials release]. Blackwell Publishing; December indinavir in healthy subjects. Pharmaco­ ther. 2003;23(7):866-870. have attempted to determine whether 14, 2005. 4. H arding A. Milk thistle ineffective for 11. Palasciano G, Portinacasa P, Palmieri V, MTE produces any adverse drug interac­ liver disease. Reuters; December 26, et al. The effect of silymarin on plasma tions. The clinical literature to date has 2005. levels of malondialdehyde in patients shown that no interactions are known,9,IO 5. Milk Thistle Safety Assessment Report. receiving long-term treatment with and in one trial, MTE actually had a bene­ Austin, TX: American Botanical Council ; psychotropic drugs. Curr Therapeut Res . ficial effect on a hepatotoxic psychophar­ 2004. 1994;55(5):537-545. maceutical drug. 11 6. Blumenthal M, Hall T, Goldberg A, In summary, considering the prepon- Kunz T, Dinda K, Brinckmann J, Woll-

The ProfileProven TM Extract Line: Ginkgo Biloba 24/6 and 24/6<1 Tested to assure no added Rutin. Fully conforms to recent AHPA Trade Recommendation. Grape Seed 85% Pol yphenols and Procyanidolic Value >95.0 Green Tea 50% EGCG and 50% Pol yphenol Saw Palmetto 160mg soft-gel, fatty acid profile verified Plus: Rhodiola Rosea, Milk Thistle, St. John's Wort and more. All products verified for active compounds Prop 65 compliant for lead content Screened for known adulterants, microbial, heavy metals & pesticides For information and other raw materials: Telephone: 866-459-4454 or Ema il: [email protected] Q Ethical Naturals Inc. NATURE VERIFIED BY SCIENCE www.EthicaiNaturals.com

www.herbalgram.org 2006 HerbaiGram 71 I 31 Research Reviews

Special Extract of Traditional African Herb Pelargonium Treats Bronchitis in Clinical Trial D eviewed: Chuchalin AG, Berman B, Lehmacher W. Treatment of acute bronchitis in adults with a Pelargonium sidoides prepara­ ftrion {EPs 7630): a randomized, double-blind, placebo controlled trial. Explore! November 2005;1(6):437-445.

Acure bronchitis is a common upper gic bronchial asthma, tendency to bleed, determine their frequency, nature, and respiratory tract infection caused primarily hypersensitivity or possible hypersensitiv­ severity using a 4-point rating scale. by the respiratory syncy tial virus (RSV), ity to the medication, severe heart, renal, Subjects in the EPs 7630 group were but also by the coxsackie, influenza, para­ liver disease, and those on other medica­ prescribed a proprietary extract of P. sidoi­ influenza, and ECHO vi ruses or adena­ tions that might impair the va lidity of the des, EPs 7630 (Dr. Willmar Schwabe viruses. Conventional medical treatment study results {e.g., antibioti cs). G mbH & Co., Karlsruhe, Germany; a is aimed primarily at reduci ng symp­ The primary outcome measure was the corresponding product is marketed in toms. Treatment with antibiotics does change in BSS compared to placebo. The the US as Umcka" ColdCare by Nature's not su bsta ntially decrease the duration secondary outcomes measured were BSS Way, Springville, UT ). The dosage was of the illness; however 70% of the cases less than 5 at the conclusion of the study, 4.5 mL {3 0 drops) 3 times daily 30 of acute bronchitis continue to be treated a decrease of BSS ;,: 5 points compared minutes before or after meals for 7 days, in conventional medicine by prescribing to baseline, consumption of paracetamol or a matching pl acebo. (EPs 7630 is an antibiotics. T his clinical trial evalu ated (aka acetaminophen, a non-prescription ethanolic extract of the root of P. sidoides the potential of an herbal medicinal prep­ analgesic), change in individual subj ects' with a drug-extract ratio of 8-10: l. The aration made of the roots commercial product is of Pelargonium sidoides D C, a solution, consisting of Geraniaceae for the treat­ 80% EPs 7630 and 20% ment of acute bronchitis. P. glycerol.) sidoides is an herb used tradi­ BSS significantly tionally in South Africa fo r decreased from 7.2 ± its abi I ity to treat various 3.1 points in the EPs symptoms of upper respira­ 7630 group compared tory tract infections. to 4.9 ± 2.7 points in This randomized, double­ the placebo group (P < blind, placebo controlled 0.0001). This showed clinical trial was conducted a highly significa nt in Russia at 6 urban primary superiority of EPs 7630 care outpatient clinics. compared with placebo Included in the study were on day seven." C linical 124 subjects (37 men, 87 superiority of EPs 7630 women, mea n age approxi­ was detected as ea rly mately 36 years) diagnosed as 3 days, with a mean with acure bronchitis and BSS at that time of 4.4 ± a Bronchitis Severity Score Pelargonium sidoides Photo ©2006 Martin Fletcher, www.californiagardens.com. 2.2 for the EPs 7630 (BSS) ;?: 5, and duration of group compared to 6.2 symptoms of ~ 48 hours. T he ± 2.5 points in rhe placebo BSS is a 5-point scale that scores bron­ symptoms of BSS , and the res ults of group from baseline to day 7 of treatment chitis symptoms, namely cough, sp utum, the SF-12 Health Survey and EQ-5D (P < 0.0001). rales/rhonchi (a crackling so und during quality of life ques tionnaires. An addi­ The results showed benefits in the EPs respiration related to congestion in the tional outcome measure was the Integra­ 7630 group based on several measure­ bronchi), chest pain during coughing, and rive Medicine Outcome Scale (IMOS), ments. BSS of less than 5 points was dyspnea (difficult breathing). which is a 5-point scale rhar rates whether noted in 61 of 64 subjects (95.3%) in the Symptoms were assessed through inter­ a subject has achieved "complete recov­ EPs 7630 group compared to 35 of 60 views with the subjects, in which a score ery," "major improvement," "slight to subjects (58.3%) in the placebo group (P of 0 = the absence of symptoms, 1 = mild moderate improvement," "no change," or < 0.0001). Similarly, a decrease in BSS symptoms, 2 = moderate, 3 = severe, "deterioration." Subject satisfaction with of at leas t 5 points occurred in 58 of 64 and 4 = very severe symptoms. Excluded rhe treatment was also assessed by using subj ects (9 0.6%) in the EPs 7630 group from the study were people who should the Integrative Medicine Patient Satisfac­ compared to 31 of 60 subjects (5 1.7%) in be receiving antibiotics (e.g., those with tion Scale (IMPSS), a 5-poinr scale with the placebo group from baseline to day 7 suspected pneumonia), people who had the ratings of "very satisfi ed," "satisfied," of treatment (P < 0.0001). These 2 crite­ been treated with antibiotics within 4 "neutral," "dissatisfi ed," and "very dissat­ ri a defined "rapid recovery," which was weeks of the study, people with aller- isfied." Adverse events were recorded to detected in 58 of 64 subjects (90.6%) in

32 I HerbaiGram 71 2006 www.herbalgram.org Research Reviews

the EPs 7630 group compared to 25 of 60 compared to 18 of 60 subjects (30.0%) of The safety and efficacy of this form ula subjects (41.7%) in the placebo group (P the placebo group were assessed as "major provides an alternative to the ineffective < 0.0001) . Symptomatic improvement of improved or completely recovered" by the conventional treatments for ac ute bron­ rales/rhonchi, chest pain during cough­ IMOS. This assessment was given to 43 of chitis. HG ing, and dyspnea after 7 days of EPs 64 subjects (67.2%) in the EPs 7630 group -John Neustadt, NO 7630 administration exceeded 90% of compared to 11 of 60 subj ects (18.3%) of that group, whereas less than 60% of the placebo group by days 3-5 of trea t­ References the placebo group experienced recovery ment. A noticeable effect of EPs 7630 I . Marrhys H , Eisebirr R, Seith B, Heger M. of these symptoms. Rales/rhonchi were treatment was described within 2-5 hours Efficacy and safety of an extract of Pelar­ absent in 55 of 60 subjects (9 1.7%) in by 2 of 64 subjects (3. 1%) and within 1- gonium sidoides (EPs 7630) in ad ulrs with the EPs 7630 group versus 29 of 59 2 days by 14 of 64 subjects (21.9%). The acute bronchitis. A randomized, double­ blind, placebo-controlled trial. Phytomed. subjects (49.2%) in the placebo group (P majority of subj ects in the EPs 7630 group 2003; 10 Supp1 4:7-17. [Reviewed as < 0.0001). Chest pain during coughing reported remiss ion of their ac ute bronchi­ HerbCiip II 0134.254. Available at: was absent in 55 of 58 subjects in the EPs tis symptoms by day 7, whereas "many h rrp: / /www. herbalgram.org/herbclip/ 7630 group (94.8%) compared to 29 of patients" in the placebo group reported review.asp?i=4378 1. Accessed June 6, 52 subjects (55.8%) in the placebo group experiencing no change by day 7. Adverse 2006.] (P < 0.0001). Cough was the symptom events we re not significantly different 2. Kolodziej H , Schulz V. Umckalaobo: that showed the slowest rate of recovery between the EPs 7630 and placebo groups. From traditional applicati on ro modern in both groups. Cough disappeared in 20 No serious advers e events were reported. phyrodrug. Deutsche Apotheke Zeitung. 2003; 143(12):55-64. of 64 subjects (3 1.3%) in the EPs 7630 T his clinical trial agrees with an ea rlier, 3. Brown D. Ex tract of Pelargonium sidoides: group compared to 3 of 60 subjects (5.0%) larger study showing the superiority of South African H erbal Remedy Success­ in the placebo group (P < 0.0001). Simi­ EPs 7630 over placebo for the treatment fully Treats Acute Bronchitis and Tonsil­ larly, hoarseness disappeared in 45 of 58 of acute bronchitis in 468 subjects. 1 A lopharyngitis. Herba!Gram. 2004;No. subjects (77.6%) in the EPs 7630 group comprehensive review of the traditional 63:17-19. Available at: hrrp://www. compared to 20 of 52 subj ects (38.5%) in uses and modern research on P. sidoi­ herbalgram.org/herbalgram/arricleview. the placebo group (P < 0.0001). des was published in 2003,2 and another asp?a=2703. Accessed June 15 , 2006. At the end of the study period, 54 of 64 recent paper reviews the clinical phar­ subjects (84.4%) in the EPs 7630 group macology of P. sidoides special extract.3

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This article is based on the author's presentation "Kava­ tially of the countries within the region, including Fiji Kava: From a traditional beverage to a risky cash-crop" and New Caledonia. A part of the crop is still exported at the International Kava Conference, Fiji, December 1, to the United States for use in herbal dietary supple­ 2004. ments, and recently the Chinese market also showed n its native areas of the South Pacific, the assess­ interest in kava. ment of quality for the traditional and highly With the kava market slowly recovering, and the I respected medicinal and ritual plant kava (Piper sources focused on few hot spots, the question of methysticum Forst., Piperaceae) is influenced by a kava quality must be discussed. In fact, there are very number of complex factors. These include the choice distinct differences in kava quality, which may also contribute to the debate on kava safety. of chemotype, the total kavalactone content, the The pharmacological properties of kava have been plant parts used, the method of preparation, and demonstrated to result from the kavalactone content the choice of fresh or dried plant material. As West­ and the chemotype (plants of the same species with ern wholesalers are usually interested in optimal genetically defined phytochemical characteristics).l,2 kavalactone contents, and not so Six major kavalactones account much in traditional experience for approximately 96% of the with a given cultivar, material Western wholesalers lipid soluble extract. They have unsuitable for daily kava drink­ and buyers of herbal been shown to be pharmaco­ ing has entered into the commer­ logically effective. There are, cial herb markets and has been raw material are mostly however, qualitative and quanti­ exported. This situation might unaware of the complex tative differences in their mode well be related to the observation of action. With respect to kavain, of hepatic adverse events with the factors influencing one of these kavalactones, the use of kava extract preparations. kava quality. greater the kavain content, the Clearly, a quality control system more agreeable the kava effect is is needed to prevent unsuitable generally felt. A clear correlation appears berween traditional use and chemotype: kava material from being exported. types favored for daily drinking in the South Pacific In the Pacific, kava cultivation occupies approxi­ are generally chemotypes rich in kavain.I Correspond­ mately 15,000 hectares. Prior to the bans on the sales of ingly, changes in batch-to-batch reproducibility of kava preparations instituted by various countries, based kava effects can also be expected with kava extracts in on alleged liver toxicity, its export value from all kava­ drugs and supplements not standardized to a constant exporting countries in the South Pacific represented kavalactone composition, especially when the exact approximately $82.5 million (US dollars, USD). As a origin of the herbal raw material is unknown to West­ major stronghold of the local economy, kava trading ern companies. contributed directly to the economic stability of the The 6 major kavalactones are used to define a partic­ region. ular kava chemotype.1 The kavalactones have been The kava bans caused significant damage to the assigned numbers according to the sequence of elution South Pacific economies, with some regions recov­ from analyses by HPLC (high-performance liquid ering faster from the unexpected economical blow chromatography): 1= desmethoxy-yangonin, DMY; than others. In Vanuatu, kava is still a major cash 2= dihydrokavain, DHK; 3= yangonin, Y; 4= kavain, crop due to the importance of the local kava-drink­ K; 5= dihydromethysticin, OHM; and 6= methysti­ ing market, which reaches $7 million (USD) per year. cin, M. Chemotypes can be identified by listing the Kava is the second export crop in value ($4.5 million numbers of the corresponding kavalactones in decreas­ USD in 2004), after copra (dried coconut meat) but ing order of their proportion in the sample. This larger than cattle meat and cocoa (Theobroma cacao method of chemotype coding allows the indication of L., Sterculiaceae). Kava is providing higher returns of a "signature" of the raw material and the comparison investment than other cash crops. Since the ban of sales between kavalactone composition and effect experi­ in Europe in 2001, the present market consists essen- enced on ingestion.

Kava Piper methysticum Photo ©2006 stevenfoster.com

www.herbalgram.org 2006 HerbaiGram 71 I 35 As a sterile plant, kava reproduces by 4. Method of preparation and dilution; vegetative propagation. The kavalactone and composmon is genetically defined.3 5. Use of fresh or dry plant material. ~) Chroma Dex Different cultivars planted on the same The local preferences for a given setting THE standard field and on the same day will reflect the chemorype are influenced by the expecta­ kavalactone composition of the mother tions of individual kava drinkers. Differ­ NEW ChromaDex plant. The same is observed for cultivars ent communities may be looking for planted in locations other than their orig­ different pharmacological effects in tradi­ 2006/2007 Catalo_g inal site. There is significant cultivar tional kava drinking and thus are very variation within and between islands for aware of quality differences. Sometimes Available April 2006 kavalactone content and composition. an intoxicating effect is specifically looked • Hundreds of NEW standards Correspondingly, the selection of favored for, whereas other users wanr to produce kava cultivars was a result of traditional a state of happy unconcern and content­ • Many new KITs experience and replanting kava culrivars ment, and facilitate conversation while with rhe most agreeable effect. staying fully alert (although this is nor the With over 3500 standards available, Kavalactone content and internal inrended purpose of kava-based supple­ we are the most comprehensive composition also vary according to the menrs). However, with excessive quanti­ supplier of phytochemical reference part of the planr. These differences are ties and especially with chemotypes too standards. independenr of the age of the planr. The rich in OHM and DHK, drinkers can total kavalactone concentration is highest suffer from photophobia (light sensitiv­ our product line Includes: in the roots and stumps, and progressively ity), diplopia (double vision), and finally, • Primary Standards decreases towards the aerial portions of nausea. T hey feel the urge to sleep; some­ • Secondary Standards the planr. The kavalactone signature may times they can be found stretched out vary between roots, stumps, and basal right at the place where they have drunk • Reagent Grade Standards stems, and these differences are main­ rhe kava. • AHP-Verified'"Standards-NEW rained while rhe plant is aging. Thus, not For local use in kava drinking, various • Snap-n-Shoot"'Standards-NEW only rhe selection of rhe culrivar, bur also kava culrivars are never mixed. Likewise, of the plant part and the geographical sire ground powders from various parts of rhe • Botanical Reference Materials-BAM of cultivation are major factors conrribut­ plant (roots, stumps, and/or basal stems) • Reference Standard Kits ing to kava quality conrrol. were never traditionally mixed together. • Complete Analytical Kits Consumption of kava is nowadays In fact, they represent differenr qual­ common nearly everywhere in Vanuatu. ity grades and are sold at differenr prices In contrast to kava use in the Fijian reflecting their total kavalactone conrenr, Contact ChromaDex to get your islands, where kava is prepared from dried the roots being more expensive than pieces 2006/2007 copy now. and pounded material, kava drinkers in of stumps and basal stems. The stumps tel. 949.419.0288 the Vanuatu archipelago have preferred are occasionally peeled to remove the bark fax. 949.419.0294 the consumption of fresh kava. Further rich in tannins and polyphenols respon­ email. [email protected] local differences refer to the method sible for the bitter taste. of kava beverage preparation, e.g., the From a phytochemical poinr of view, way it is diluted and filtered. Numerous fresh and dry kava are also very differ­ chemotypes have been selected for diverse ent. The chemical composition of the uses. Kava can be ingested for medicinal fresh juice is much more complex than reasons, to treat particular symptoms, or the composition of the dry powder, as for daily consumption as a recreational numerous acidic, volatile or enzymatic beverage. Some varieties are famous for compounds are lost during the drying the very subtle pharmacological effect process. Obviously, there are more compo­ they produce.1 nents than just the kavalactones conrrib­ The local definition of kava quality in uting to the overall effect. For a given the South Pacific communities reflects cultivar, 2 very different brews can be distinct cultural backgrounds. It can refer prepared using dried or fresh roots of the to a sudden feeling of being "high" or to same plant. a very gentle relaxing effect; the beverage The subtle combination of parame­ can have a very bitter taste or a slightly ters, factors, and conditions necessa ry spicy flavor. to achieve a defined quality results in In conclusion, the quality of kava differenr local brews, similar to vinrages depends on 5 major conditions and on of fine wines. The quality of kava could their complex combination: therefore be regulated by the use of 1. Chemorype and thus the inter­ geographical indicators to develop a qual­ nal proportions of rhe major ity system similar to the French "appel­ kavalactones; lation d'origine" known for wine. This 2. Total kavalactone content and rhus system could include the use of indica­ overall kavalactone quantiry; tors relating to a specific village, island, 3. Plant parr used for kava preparation; or country, when the morphotypes (plant

36 I HerbaiGram 71 2006 www.herbalgram .org types of the sa me species sharing the Vincent Lebot, PhD, is a plant geneticist same shape features, but not necessarily with experience in kava germplasm char­ the same phytochemical characteristics) acterization and evaluation. He special­ and/or chemotypes are closely related to a izes in root crops agrobiodiversity research particular geographical area. with issues related to the genetic improve­ The possibility of the use of unac­ ment of their quality and chemotypes. He ceptable kava material should at least is affiliated with C!RAD (Centre Inter­ be taken into account when addressing national de Recherches Agronomiques pour the alleged case reports of liver toxicity. le Developpement) a French institution •••• • Western wholesalers and buyers of herbal working for developing countries. E-mail: • • raw material are mostly unaware of the lebot@ciradfr. •••• complex factors influencing kava quality. The usual parameter here is kavalactone bic:luminex content only, regardless of kavalactone Bioluminex'" a revolutionary new signature or traditional experience. Kava analytical bioassay is exported as biomass (roots, stump, stem, and/or peelings), and the price of the raw Bioluminex'" is a new assay for material correlates with kava lactone quan­ biological activity and toxicity tity, not quality. This system is clearly screening of complex sample mixtures such as foods, beverages, inadequate for kava and leads to abuses dietary supplements and waste water. and negative effects on the trade. Stem This unique and effective technology peelings are traditionally considered as by­ was invented by Bayer to combine products and may contain pipermethys­ Thin Layer Chromatography (TLC) tine, an alkaloid known to be toxic to liver with the use of bioluminescent marine cells when applied in vitro.4 (However, bacteria, Vibrio fischeri , as a bioassay detector. Bioluminex'" is a fast, reliable, the possible clinical significance, if any, economic tool for quality control, of this finding is not yet determined; no research and manufacturing of food pipermethystine was found in German­ related products or water. produced kava products and roars/peel­ ings of noble kava and tudei-kava.) Key Benefits of Bioluminex.:" Alkaloids in P. methysticum are found • Greatly enhances TLC with a only in plant parts exposed to sunlight. biological detector This kind of plant material was never used traditionally by South Pacific commu­ • Rapid results nities unless thoroughly peeled-but is exported to Western wholesalers as • Easy-to-use "kava ." The former tremendous increase • Works with almost any sample type in kava trading led to the search for lower Kava Piper methysticum Photo ©2006 cost sources of raw kava material to satisfy stevenfoster.com • Wide application base demand, although that demand has obvi­ ously dropped considerably in recent years • Determination of both "active" since the bans on kava in several coun­ References and "toxic" compounds tries. Kava growing is slow, with an aver­ I. Lebor V, Merlin M, Lindstrom L. Kava, • Cost effective (low cost per assay) age maturing time of 4-5 yea rs prior to the Pacific elixir. New H ave n: Yale harves ting. Some farmers tend to respond University Press; 1992. 2. Singh YN. Kava: From Ethnology to Phar­ to the market demands by planting fast­ macology. Boca Raron, London, New growing, robust, early-maturing variet­ York, Washington: CRC Press; 2004. ies with high kavalactone contents to 3. Lebor V, Levesque J. Gener ic conrrol satisfy biomass buyers. Unfortunately, of kavalacrone chemorypes in Piper these chemotypes are not suitable for kava methysticum culrivars. Phytochemistry. drinking because of potentially unpleasant 1996;43(2):397 -403. and adverse effects. After the closure of 4. Nerurkar PV, Dragull K, Tang CS. In vitro roxiciry of kava alkaloid, piperme­ the kava markets in Europe, this kind of To learn more about Biolurninex '" or rhysrine, in H epG2 ce ll s compared ro raw material is now locally traded within for a detailed brochure of applications kavalacrones. Toxicol Sci. 2004;79( I ): I 06- please contact us at: the South Pacific. Already, local consum­ 111. ers are ex pressing their complaints about 5. Russmann S, Barguil Y, Cabalion P, bad kava quality throughout the South Krirsanida M, Duher D, Laurerburg Em~ ChromaDex Pacific region. There is also the possibility BH. Hepatic injury due ro rradirional that the most recent case reports of liver aqueous exrracrs of kava roor in New 2952 S. Daimler St. Santa Ana, CA 02705 adverse events from New Caledonia are Caledonia. Eur J Gastroenterol Hepatol. 2003; 15 (9) : I 033-1036. tel. 949.419.0288 related to this kind of unacceptable qual­ fax. 949.419.0294 ity "kava."5 HG email. [email protected] web. www.chromadex.com

www.herbalgram .org 2006 HerbaiGram 71 I 37 Tibetan Herbal Medicine

Traditional Classification and Utilization of Natural Products in Tibetan Materia Medica

by Alessandro Boesi, PhD, and Francesca Cardi, PhD

The Project everal studies on Tibetan civilization have been carried out up to now, yet some aspects of Tibetan traditional knowledge are still not well-known, such as the way local people conceive the environment, plants, and animals, and the way of prac­ Sticing Tibetan medicine and exploiting medicinal substances. Previous research on Tibetan medicine has mainly provided information on theoretical aspects. Only recently have some scholars starred to document the ongoing transformations of this science.l,2,3.4,5 Between 1998 and 2004, a research project on Tibetan ethnobiology and pharmacopeia of traditional medicine was carried out by the authors in the context of a doctoral program in Biological Anthropology. The ai m of the research was to study plant conception, classification, and exploitation among Tibetan populations, as well as to assess the Tibetan materia medica and medical practice, from the gather­ ing of medicinal substances to the processing and administra- tion of medicaments. Particular attention has been given to the evaluation of the knowledge of traditional doctors and to the contemporary evolutions of medical activities in Tibetan regions. This study is interdisciplinary, involving several speciali­ ties such as anthropology, botany, ethnobotany, and tibet­ ology. To obtain exhaustive information, the fieldwork was carried out for a period of 16 months in collaboration with traditional doctors of different educational levels who were located in different Tibetan regions: east Tibet (Litang County, Sichuan, China), Ladakh (India), and different areas of Nepal (Dhorpatan and Baragaon). The following anthropological meth­ ods were the most commonly used during the investigation: partici­ pant observation, open-ended conversations, and to a lesser extent, semi­ A medicament formula structured interviews. before the crushing, Dhor­ Excerpts of classical texts of Tibetan medicine6,7,B and of some traditional and patan Tibetan settlement modern treatises of Tibetan materia medica9, 10 were translated to analyze medicinal plant (Central Nepal), June 1998. Photo 2006 ©Alessa ndro conception, classification, and identification systems. Comparisons with the field data were Boesi. made. Plant and mineral specimens (approximately 350) were gathered and identified, their traditional classification and use documented. Medicinal plants were deposited at the Herbarium of the Museum National d 'Histoire Naturelle de Paris, France, and mineral samples were deposited at the Museo di Storia Naturale di Milano, Italy.

38 I HerbaiGram 71 2006 www.herbalgram.org Potala Palace of Lhasa, Tibet, first erected in the seventh century, then reconstructed to its present state in 1645 under the reign of the fifth Dalai Lama. The palace has served as a residence for Dalai Lamas and the sea t ofTibetan government. Photo© Qiangba Danzhen- FOTOLIA

Field data have shown that the traditional doctor's individual knowledge is crucial, influ­ At the popular level, encing classification, identification, and use of the materia medica, and that the recent politi­ traditional botanical cal, demographic, and socio-economic transformations of Tibetan societies directly affect medical knowledge and practice. 11 At the popular level, traditional botanical knowledge is knowledge is unevenly unevenly spread according to profession and education and is rapidly disappearing.I2 Some spread according of the research findings on the classification and identification of the materia medica are to profession and reported in this article. education and is rapidly Tibetan Medicine disappearing. ibetan medicine is practiced over a vast area, which covers all the regions inhabited by Tpopulations of Tibetan language and culture, as well as other areas: the northern states of India (Jammu & Kashmir, Himachal Pradesh, West Bengal, and Sikkim), Bhutan, a large part of the northern regions of Nepal, and the Chinese Provinces of Tibet (Xizang), Qinghai, Gansu, Sichuan and Yunnan. It is also practiced in Mongolia, Buryat (Russia), and many other countries where Tibetans have settled. The medical system is the result of the blending of different medical traditions and prac­ tices that come from the most important Asian medical sciences: Ayurveda, traditional Chinese medicine, and the middle-east tradition. These kinds of medical knowledge, intro­ duced into Tibet from the 7th century onwards, were superimposed and integrated with the pre-existing medical tradition of Tibetan regions, which at first were probably scarcely developed and gave particular weight to magic and religious rituals. Gradually, a distinct system of medical theories and practices developed, rational and homogeneous, which gave origin to a new medical science, Tibetan medicine, completely independent from the tradi­ tions which had influenced its evolution. That entire various medical learning was gathered,

www.herbalgram.org 2006 HerbaiGram 71 I 39 probably between the 8th and the 12th centuries, in a text from the lower regions of India, Nepal, and C hina. composed of 4 volumes, The Four Tantras ( Gyushi, rGyud Several medicinal plants grow in tropical and sub-tropi­ bzhi),6 nowadays still the fundamental reference for all ca l regions. Nowadays, these substances are ava ilable on students and practitioners of Tibetan medicine along with local markets. The gathering of plants may be influenced its famous commentary The BLue BeryL (Vaidurya sngon by their ava il ability and other facrors, and practitioners po),l produced in the 17th century by the Regent Sangye orga nize them according ro specific rules and timings. Gyatso (1653-1705). 13 Tibetan medicine is currently Medicinal substances may be classified on the bas is of practiced in several form s such as private clinics, medical different criteria, e.g., their "hot" or "cold" properties, institutes, and dispensari es. Iris taught at medical schools other therapeutic properties, as well as morphological, or rransmined by mas ters through a lineage of disciples biological, and environmental features. One of the most and family lineages. common classifications of the materia medica reported Ir is worth noting that, although practitioners employ by the informants (and also described in medical texts) the same Tibetan classical and modern texts devoted ro points out the 9 categories shown in Table 1. theory and practice, Tibetan Medicinal substances may be assembled according ro Although practitioners employ medicine is a complex and various criteria . The category of the woody medicines is heterogeneous system of worked out on the bas is of the presence of woody organs. the same Tibetan class ical and thought whose presentation The categories of herbaceous medicines and medicines modern texts devoted to theory and practice is not standard­ of the plains are worked out on the basis of several crite­ and practice, Tibetan medicine ized and uniform. Our field­ ria: morphological, biological, and environmental. A work has shown that the way single criterion, the healing properties of the medicines, is a complex and heterogeneous ro practice this medical tradi­ is employed for the category of essence medicines. We system of thought whose tion is subject ro variations emphas ize that regarding the category of precious medi­ presentation and practice is not according ro several facrors, cines, its construction is also inspired by religious beliefs. e.g., environmental condi­ Medicinal substances are commonly named according standardized and uniform. tions, family medical line- ro Tibetan standard designations that are also reponed ages, local traditions, medical in wrinen sources, but practitioners may use regional schools, medical centers, the influence of religious insti­ names and synonyms. Several substances are designated tutions, and foreign influences both from other medical with names of Sanskrit origin, in particular the ones traditions and from modern western medicine. imported from India and Nepal, which are also employed in Ay urvedic medicine. Tibetan Materia Medica ccording to the Tibetan "science of healing," sowa Categories of Tibetan Materia Medica Arigpa (gso ba rigpa), medicinal substances, along with recious medicines include precious and semiprecious diet, behavioral rules, and ex ternal treatments, represe nt a Pstones, such as emerald, diamond, and lapis lazuli; means ro eliminate sickness and re-establish the humoral metals (gold, silver, iron); and mineral substances of balance of the body. In Tibetan medicine, most medici­ animal origin such as coral, pearls, and conches. These nal agents are not used separately, but are mixed and substances are considered doubly precious according ro processed into complex medicines. Ingredients are chosen their economic value and ro their symbolic and religious according ro their individual therapeutic properties and importance, since Buddhism and medicine are inter­ ro their capacity of performing a coordinate and syner­ related. Although Tibetan doctors affirm that every getic action. element of the materia medica is equally important in Tibetan materia medica, influenced mainly by Ayurveda the preparation of remedies, this category of medicines is after the translation of several treatises of Indian origin, generally considered ro be very powerful. In fact, a type has been enriched and modified during the centuries of medicament named Precious Pill, the therapeutic effect according to the needs of the Tibetan population and has of which is particularly renowned, is mainly composed been adapted ro local environmental conditions. Even of substances that are included in this special category. during the present time, in relation ro recent transforma­ tions of the society and environmental changes, the mate­ ria medica is evolving.I 4 Table 1: Categories of Tibetan Materia Medica The most important traditional pharmacopeias Medicinal Substances Ti betan Names employed roday are the CrystaL Block (She! gong) and the precious medicines rin po che'i sman complementary text of it, the Crystal Rosary (She! phren g), 8 both written in the first half of the 18th century. The stone medicines rdo'isman ge neral texts of Tibetan medicine, The Four Tantras and earth medicines (soils) sa'isman The Blue Beryl, also have a section devoted ro describing salt medicines tshwasman the potency (nus pa) of medicinal substances. Although the above texts usually play a basic role in the education essence medicines rtsi sman of docrors, our research has shown that oral information woody medicines shing sman is crucial, in particular as far as practical activities and the medicines of the plains thong sman use of medicinal substances are concerned. Medicinal substances, man dza (sman rdzas), include herbaceous medicines sngosman drugs of plant, mineral, and animal origin. They are medicines coming from living srog chags sman gathered directly on the Tibetan plateau or are imported beings

40 I Herba iGram 71 2006 www.herbalgram.org The category of stone medicines includes several kinds of In Tibetan traditional medicine, the term thang sman minerals, e.g., calcium carbonate, pyrite, and magnetite. has 2 distinct meanings and utilizations. It is employed Earth medicines and salt medicines are small categories: either to indicate the category of medicinal plants, as drugs such as Vermiculitum are included in the former, reported above, or to designate a kind of medicinal prepa­ and sulphur in the latter. Both categories present a similar ration, notably decoctions. In the first case the meaning internal division in 2 sub-groups: natural (rang byung ba) of thang is "flat area"; in the second case it is "soup." It and artificial (bcos pa) . The categories of stones and earths mentioned above include only elements of mineral origin, except one. Curi­ ously, practitioners consider a particular lichen as an herba­ ceous plant, i.e., the one designated dodreg (rdo dreg, Parme­ Lia spp., Parmeliaceae); the Tibetan name means "incrusted on the stone." However, the majority of practitioners put this lichen in the group of medicinal stones because it appears to be growing directly on the rocks, while others place it among the medicinal earths category. The category of essence medicines includes drugs apparently very dissimilar coming from plants, miner­ als, and animals, e.g., camphor (ga bur, Cinammomum camphora [L.] Nees & Eberm., Lauraceae), cardamom (sug smel, Elettaria cardamomum Maron, Zingiberaceae), saffron (gur gum, Crocus sativus L., Liliaceae), musk, bear bile, and bitumen. Why do Tibetan docrors classify them together? According to practitioners, the main charac­ teristics they share are their strong potency and their particular fragrance. Due to this strength of potency and fragrance, they are employed in small amounts. The woody medicines, the medicines of the plains, and the herbaceous medicines include only drugs of plant origin. The woody medicines include drugs coming from trees and shrubs. Among the few of them gathered directly on the Tibetan plateau, the most common are shug pa Uuniperus spp., Cupressus spp., Platycladus orien­ talis (L.) Franco, Cupressaceae); dali (da Lis, Rhododendron spp., Ericaceae); and several types of honeysuckle such as kishin (khyi shing, Lonicera thibetica Bur. & Franch., Caprifoliaceae) and tarbu (star bu, commonly called sea ug chos dmar po (pronounced: ugcho marpo) lncarvillea grandiflora. Xiangcheng County (Sichuan, China), 4120 meters altitude, May 1999. buckthorn in the West, Hippophae spp., Elaeagnaceae). Photo 2006 ©Alessandro Boesi. Many come from tropical and sub-tropical regions, such as the Indian sandalwood tsendenmarpo (tsan dan dmar po, Pterocarpus santalinus L. Papilionaceae), different comes from the Chinese language and particularly from types of myrobalam (a ru ra, Terminalia chebula Retz., the thang preparation employed in Chinese medicine. Combretaceae), and ba ru ra (T beLLerica C.B. Clarke, Several Tibetan informants mistakenly report that the Combretaceae). The category is structured in 7 sub­ term thang sman only designates medicinal plants that are groups; they correspond to the anatomical parts of plants used to prepare decoctions. used in medicine: seeds and fruits, flowers, leaves, stems, Derailed descriptions of the botanical characteristics branches, barks, and resins. of the plants included in the 2 categories are seldom The following 2 categories, medicines of the plains and reported. In this case, they correspond nearly to the herbaceous medicines, have a similar internal organiza­ ones reported in traditional texts such as the Crystal tion. While some informants report this classification, Rosary. The informants affirm that the medicines of many of them do not differentiate the 2 groups, recogniz­ the plains may be bulky herbaceous or sometimes tiny ing only a single category designated tsa man (rtswa sman, woody plants, whose stems and roots are more devel­ "herbaceous medicines"). Others, influenced by modern oped than those of the herbaceous medicines, such as texts, name it by joining the 2 terms sngo (herbaceous) pashaka (ba sha ka, Adhatoda vasica Nees, Acanthaceae), and thang (plains). However, many informants through­ thangdromnagpo (thang ph rom nag po, Anisodus tanguticus out different Tibetan regions affirm that the distinction Pasher, Solanaceae), and chum (!cum , Rheum palmatum of these 2 groups has no practical utility. The majority L., Polygonaceae). Conversely, plants belonging to the of the informants have little or no knowledge of the 2 herbaceous medicines have an herbaceous aspect, with a categories or of the features that differentiate them. They slender stem and tiny underground organs such as ugchd generally report that the medicines of the plains grow marpo (ug chos dmar po, IncarviLiea grandiflora Bur. Er in the area of the Tibetan plateau at lower and medium Franch., Bignoniaceae) (see photo this page) and tser non altitudes and that herbaceous medicines grow on high (tsher sngon, Meconopsis horridula Hook. F. & Thoms., mountains. Papaveraceae).

www.herbalgram.org 2006 HerbaiGram 71 I 41 The last category reported by the informants is the one bears in his/her mind one ideal model, which allows the of medicinal substances coming from living beings. It immediate recognition of all the plants included in the includes substances that belong to the animal kingdom. same class. This model, based on his/her experience and Hence, the medicinal substances previously described, region of origin, usually constitutes the most typical plants included, are not considered as living beings. specimen of the category. Yet, in Tibetan medicine, the Tibetans regard as living beings only the substances that "prototypical" system seldom allows the precise recogni­ have a conscious principle (sems). tion of medicinal plants, representing only the first stage Drugs are listed by anatom­ of the identification process, i.e., the examination of ical parts and organs and the plant's general aspect. Actually, the "componential­ Identification is complete only are divided into numerous conceptual" identification system is essential to recognize when specific features evaluated sub-groups such as horns, and exactly designate medicinal plants. Identification is for each plant correspond to the eyes, tongues, teeth, hearts, complete only when specific features evaluated for each and lungs. Some insects and plant correspond to the ones known by the doctor, on the ones known by the doctor, on other small invertebrates may basis of his/her experience and education, and to the ones the basis of his/her experience be included in another sub­ described in the treatises of Tibetan materia medica. Only and education, and to the ones group. T he same living being then can the plant be gathered and employed in medicine. may be repeatedly listed A practitioner's experience and education, along with text described in the treatises of according to its different information, represent concurrent aspects of this task. Tibetan materia medica. Only then anatomical parts; for exam­ Morphological features, taste, scent, and the environment can the plant be gathered and ple, the stag, which appears where the plant grows-the most important plant char­ both in the horn and in the acteristics examined-are analyzed below. employed in medicine. blood sections. Although many substances of animal Morphological features origin are included in the materia medica, Tibetan doctors o describe the importance of the analys is of minute do not frequently use them. Some possible reasons are Tmorphological features in plant identification, we take their rarity, high cost, and the recent promulgation of as an example 2 categories of medicinal plants: lug ru (lug regulations protecting the fauna. ru , sheep's horn, Pedicularis spp., Scrophulariaceae) and lang na (glang sna, elephant's trunk, Pedicularis spp.). The Identification of Medicinal Plants Pedicularis (lousewort) is a genus of semicparasitic plants, wing to the great extension of the area over which often conspicuous in the alpine zone all over the Tibetan OTibetan medicine is practiced, the materia medica shows differences according to the region, climate and vegetation, local traditions, the activities of medical institutes, and foreign influences. All these factors may influence plant identification. Hence, different plants (i.e., from different genera and species from the botani­ cal perspective) may be designated by the same Tibetan name. The ability to accurately identify medicinal plants can be acquired only after several years of study and practice with the guidance of a learned master. It involves not only the identification of plants from their morphologi­ cal features and the recognition of the subtle differences between plant varieties, but also the ability of evaluating their therapeutic properties through the analysis of vari­ ous plant and environmental features. Two systems may be distinguished in the identification process employed by Tibetan practitioners: "prototypical" and "componential-conceptual."l5, 16 The former allows the practitioner to recognize the plant and to attribute a name to it after the observation of its general features, employing an ideal model, which evokes and supports the botanical nomenclature. The latter is based on the evaluation of the presence of one or several characteristics, which represent the necessary condition to recognize the plant. Thus, this identification process implies the atten­ tive analysis of specific features of the plant. Many Tibetan doctors examine the general aspect of a plant without considering its minute features, and recog­ nize it almost instantaneously, as in the case of rechagpa (re lcag pa, Stellera chamaejasme L., T hymelaeaceae) and dwa ba (pronounced: da wa) Arisaema nepenthoides. Dhorpatan dawa (dwa ba , Arisaema nepenthoides [Wallich] Martius (Central Nepal), 3120 meters altitude, May 1998. Photo ©2006 Ales­ ex Schott, Araceae) (see photo this page). The practitioner sandro Boesi.

42 I HerbaiGram 71 2006 www.herbalgram.org One of the areas where the research fieldwork was ca rri ed out. The so-called Gompa easternmost camp of the Nordzinling Tibetan settlement of Dhorpatan Bag lung Distri ct (Central Nepal), 2900 meters altitude, April 1995. Photo ©2006 Alessandro Boesi. plateau and the Himalayan Mountains. According to the Sometimes, the morphological identification param­ recent Flora oJChina,17 among the 352 species of Pedicu­ eters of the same plant may vary as in this example laris present in China, 271 are endemic, and many thrive concerning the identification of cha rkan (bya rkang). on the Tibetan plateau. The flower of the lousewort has a The specimens of this plant that we gathered in Tibetan corolla, which is two-lipped. The upper lip is hooded and regions belong to the genus Delphinium: Delphinium often prolonged into a beak, which may be slightly circu­ cashmerianum Royle, Ranunculaceae in Ladakh; D. lar or trunk-shaped. caeruleum in the Litang County (Sichuan, C hina); Tibetan practitioners ofLitang County (East Tibet) and and D. grandiflorum L. in Baragaon. According to the other Tibetan areas identify louseworts in the following majority of practitioners and texts, 8 the flower of the cha manner. After a rapid evaluation of the general aspect of rkan must be similar to the head of the hoopoe (Upupa the plant, they attentively examine the morphology of the epops), and they affirm that one of the Delphinium flower and in particular its beak, which may be called horn exhibits that characteristic. Conversely, a traditional or nose, according to its shape. When the beak is slightly doctor from Khyungbo, a region located in East Tibet, circular, it is called horn, and the plant is identified as lug names cha rkan as a totally different plant, which has ru. In this case, the beak of the flower is associated with the been identified by us as a fern (Pteridium aquilinum [L.] horn of a sheep. When the beak of the flower doesn't bend Kuhn var. wightianum (]. Agardh) Tryon, Dennstaed­ on one side, but it bends directly forward, looking like tiaceae). That practitioner refers directly to the plant an elephant's trunk, the plant is called lang na, meaning name cha rkan, meaning "bird's feet ," for the identifica­ "elephant's trunk." The plants included in the group called tion. Actually, he showed us that the not-fully-opened lug ru are mainly identified according to the color of their buds of that fern have a striking similarity to bird feet flowers (and to the features of the environment of growth), and constitute the element, which allows him to identify while the ones belonging to lang na are identified according the plant as cha rkan.I B to flower size and position, and leaf position. www.herbalgram.org 2006 HerbaiGram 71 I 43 Taste underground part, changed his mind, because the scent did not correspond to the one proper to that plant. There­ n important plant fearure, which has to be care­ fore, he concluded that, as concerned the morphology and fu lly examined, is its taste (ro), because taste allows A the taste, that plant was very similar to pang pd, but as to the practitioner to both recognize the plant and to assess irs scent, it was different. Hence, rhar plant could not be irs potency. In Tibetan medicine rhe 6 tastes (sweet, idemified as pang pd and could nor be used in medicine. acid, sa lty, bitter, hot, as tringent) are considered cura­ After a few days, we climbed with the sa me informant to tive properties . They are produced by the dominant the place where we had gathered that plant. This time the 2 of the 5 elements (the fundamental constituents of practitioner, after analyzing the scent of a fresh specimen, matter) of which each plant is formed. T he 5 elements are identified it as pang pd. All the above is to demonstrate the fundamental constituents of all substances and are that without its scent this plant can't be exactly identified. responsible for all their fearures and qualities. Thus, most We note that plant potency (i.e., as a medicine) may also practitioners, as in the case of dzinpa dadrel ('dzin pa zla be ascertained through rhe evaluation of its fragrance, bral, Aconitum gymnandrum Maxim, Ranunculaceae), which is also dependent upon the 5 elements: certain after observing plant morphology, crush with the teeth plants without their proper fragra nce cannot be employed a portion of the plant and keep it for a while on the as medicines, since they would be deemed to be lacking in tongue (see photo on cover page). The taste has to corre­ therapeutic properties. spond to the one indicated in the texts for that plant or according to rhe experience Table 2: Traditional Tibetan Medicinal Plants Mentioned in this Article of rhe doctor. Species Family Tibetan name Parmelia spp. Parmeliaceae rdo dreg Platyc/adus orienta/is (L.) Franco Cupressa ceae shug pa In Tibetan medicine, examining Juniperus spp. Cupressaceae shug pa the environment where the plant Cupressus spp. Cupressaceae shug pa grows is crucial because it affects Elettaria cardamomum Maton Zingiberaceae sug smel its potency: the hot power of the Crocus sativus L. Liliaceae gurgum sun prevails on the sunny slopes, Cinammomum camphora (l.) Nees & Lauraceae gabur whereas the cold power of the Eberm. moon prevails on the shady ones. Rhododendron spp. Ericaceae da lis In the same way, the altitude Lonicera thibetica Bur. & Franch. Caprifoliaceae khyi shing influences the cold nature or the Hippophae spp. Elaeagnaceae star bu hot nature of the plant, increasing Pterocarpus santalinus L. Papilionaceae tsan dan dmar po or decreasing its potency. Terminalia chebula Retz. Combretaceae a ru ra Terminalia be/Jerico C. B. Clarke Combretaceae ba ru ra Anisodus tanguticus Pasher Solanaceae thong khrom nag po Rheum palmatum L. Polygonaceae /cum Scent Adhatoda vasica Nees Acanthaceae ba sha ka siruation which took lncarvil/ea grandif/ora Bur. Et Franch. Bignoniaceae ug chos dmar po place on the field in A Meconopsis horridula Hook. F. & Thoms. Papaveraceae a byag tsher sngon East Tibet confirms the importance of the evalua­ Arisaema nepenthoides (Wallich) Araceae dwaba tion of scent for the identi­ Marti us ex Schott fication of medicinal plants. Stel/era chamaejasme L. Thymelaeaceae re Jcag pa We showed a Tibetan doctor Pedicularis spp. Scrophulariaceae lug ru a specimen of Nardostachys grandiflora D C., Yaleriana­ Pedicularis spp. Scrophulariaceae glang sna ceae that had been gath­ Delphinium cashmerianum Royle Ranunculaceae bya rkang ered a few hours previously Delphinium caeruleum Ranunculaceae bya rkang on the mountains. T he doctor, after examining the Delphinium grandiflorum L. Ranunculaceae bya rkang morphological features and Pteridium aquilinum (L.) Kuhn var. Dennstaedtiaceae bya rkang taste of that specimen, iden­ wightianum (J. Agard h) Tryon tified it as pang pd (spang Aconitum gymnandrum Maxim. Ranunculaceae 'dzin pa zla bra/ spos)-the Tibetan name of the plant mentioned above Nardostachys grandiflora DC. Valerianaceae spang spas as N. grandiflora-but after Aconitum violaceum Jacquem. ex Stapf. Ranunculaceae bong nga nag po evaluating the scent of its

44 I HerbaiGram 71 2006 www.herbalgram .org Environment illustrations of plants and other medicinal su bstances. During gathering trips or at drug markets, many doctors n the identification process, the observation of the envi­ employ it to identify plants using the illustrations. Ironment where the plant grows is important, because it allows the practitioners to make a selection. Certain plants thrive only in particular ecological settings. The distinction between the shady side (srib) and the sunny side (nyin) of the mountains is fundamental. In fact, in the Tibetan perception of the environment in general and, in particular, in plant identification, that differentia­ tion is a crucial factor because it denotes different growing areas, each one with specific characteristics, where only particular plants can grow. Furthermore, in Tibetan medicine, exa mining the environment where the plant grows is crucial because it affects its potency: the hot power of the sun prevails on the sunny slopes, whereas the cold power of the moon prevails on the shady ones. In the same way, the alti­ tude influences the cold nature or the hot nature of the plant, increasing or decreasing its potency. That is the case of a plant with a cold potency such as the bon na nagpo (bong nga nag po, Aconitum violaceum Jacquem. ex Stapf., Ranunculaceae).12,18 The informants do not pluck the individuals growing on the sunny side of the moun­ tains because the hot nature of the sun dissipates their cold potency. On the contrary, the ones that grow in the highest places of the shady slopes are the most appreci­ ated because the cold power of the spot is very strong. There are also plants whose properties are not particularly influenced by environmental features such as the tserndn (Meconopsis horridula Hook. F. & Thoms., Papaveraceae) (see photo this page), a type of Himalaya n blue poppy. Interestingly, the doctor may decide to pluck the same plant in a different site according to the therapeutic prop­ erties required. The role of literary sources in the identification process any traditional6,7,8 and modern texrs9,!0 describe Mand illustrate the materia medica of Tibetan medi­ cine. They give general information about plant catego­ a byag tsher sngon (pronounced: a ciag tser non) Meconopsis horrid­ ries and very concise descriptions of plant morphology u/a. Litang County (Sichuan, China), 3920 meters altitude, June 2000. and of their environment of growth. The authors often Photo ©2006 Alessandro Boesi. use comparisons with other plants or metaphors, which describe the plant organ, using an animal or its organ as Conclusion a model of similarity. These descriptions certainly cannot he knowledge of rhe materia medica is moderately be employed to carry our the identification a priori, diffused throughout Tibetan regions, and the dispar­ because they imply subjective interpretations. Actually, T ity of competence among practitioners is significant. plant identification is not carried our employing these Modern generations of practitioners are principally skilled texts, bur on the basis of the individual experience of the in the diagnosis and administration of the remedies. Only practitioner. a limited number of highly educated and well-experi­ These treatises are used by practitioners who are already enced Tibetan doctors have a deep knowledge of medici­ able to recognize medicinal plants and may use the infor­ nal plant classification and identification criteria. One of mation to distinguish the different varieties of a single the reasons explaining that phenomenon may be related plant. This may be very important because each type of to a recent trend, which is becoming increasingly impor­ plant often has distinct healing properties or a distinct tant in the last decades-the recent standardization and technique of use. In this way written information in industrialization of drug processing in Tibetan medical Tibetan texts and the oral information received by the institutes, and the specialization of practitioners. 11 teachers allow the practitioner to recognize the plant. The Medicinal substances are similarly conceived in the modern treatises of Tibetan materia medica published in regions studied. Traditional doctors seem to attribute Chinese Tibet in rhe last decades have been spreading little importance to their classification in categories (as increasingly all over Tibetan regions. We noticed rhe rapid shown in Table 1) and prefer distinguishing drugs on diffusion all over Tibetan cultural regions of a recent text the basis of their qualities and therapeutic properties. of Tibetan pharmacopeia,9 which also presents numerous

www.herbalgram.org 2006 HerbaiGram 71 I 45 A general tendency consists in simplifying the tradi­ Alessand ro Boesi obtained his PhD in Biological tional classification according to practical evaluations. Anthropology in 2004 at the Universite de Ia M edi­ The same happens with modern Tibetan pharmacopeias terranee, M arseille, France. His thesis is titled "Le (edited in C hinese Tibet), some of which m ay also include savoir botanique des Tibetains: conception, classifica­ additional substa nces, probably under Chinese influence, tion et exploitation des plantes sauvages." Alessandro that do not appear in classical Tibetan treatises. has conducted fieldwork in Ladakh (India), N epal, and As far as the identification of medicinal plants is Tibet (China) since 1994, focusing on Tibetan ethno­ concerned, it is not only based on the analysis of the botany and the materia medica ofTibetan medicine. He is morphology of the plant, but also takes into account other affiliated with Shangdril (www.shangdril.org), a research properties such as its taste a nd smell, and the features of center at the Museo di Storia Naturale di Milano (Italy) the environment where it grows. Taste, smell, and envi­ and works as a lecturer for Italian universities. ronment are important features, which are employed both Francesca Cardi obtained her PhD in Anthropology to recognize the plant and to assess its healing properties in 2004 at the Universite de Ia Mediterranee, M arseille, and quality at the same time. France. For the last 10 years she has carried out extensive research in several Tibetan regions, focusing on T ibetan pharmacopoeia, medicament production, and the prac­ tice of traditional doctors. She is a member of the research center Shangdril (Italy) and collaborates with Italian universities and institutions such as Universira di Pavia and Museo di Etnomedicina di Genova, and also with scientific publishers and pharmaceutical companies.

References I . Craig JR. T he transformations of Tibetan medicine. Medi­ cal Anthropology Quarterly. 1995;9(1):6-39. 2. Vincanne A. The Sacred in the Scientific: Ambiguous Practices of Science in Tibetan Medicine, Cultural Anthro­ pology. 2001; 16(4):542-575. 3. Cardi F. The exploitation of natural resources among Tibetan doctors, evo lutions of the Tibetan medical knowl­ edge in the socio-economical context. In: A. Boesi & F. Cardi (eds.). Wildlife and plants in traditional and modern Tibet: co nceptions, exploitation, and conservation. Memo­ rie della Societa !taliana di Scienze Naturali e del Museo Civico di Storia Naturale di Milano. 2005;33(1): 19-33. 4. Cardi F. Principles and methods of assem bling Tibetan medicaments. The Tibet journal. In press. 5. Glover OM. T he Land of Milk and Barley: Medicinal Plants, Staple Foods, and Discourses of Subjectivity in Rgyalthang. In: Schrempf M, ed. Soundings in Tibetan Medicine: Histo rical and Anthropological Perspectives. Proceedings ofthe 1(Jth Seminar of the International Associa­ tion ofTibetan Studies (PlATS), Oxford Sept 6-12, 2003. Leiden: Brill Publishers. In press. 6. The Four Tantras. g.Yu thog yon tan mgon po. bDud rtsi snying po yan lag brgyad pa gsang ba man ngag gi rgyud, Bod lj ongs mi dmangs dpe skrun khang, Lhasa; 1992. 7. The Blue Beryl. sDe srid sangs rgyas rgya mtsho. gSo ba rig pa'i bstan bcos sman bla'i dgongs rgyan rgyud bzhi'i gsal byed bai dur sngo n po'i mli ka zhes bya ba bzhugs so. Lhasa: Bod lj ongs mi dmangs dpe skrun khang. Vol 2. thong khrom nag po (pronounced: tan dram nag po) Anisodus 1982: 1468. tanguticus. Lita ng County (Sichuan, China), 3930 meters altitude, July 8. The Crystal Block and the Crystal Rosa ry. De'u dmar dge shes 1999. Photo ©2006 Alessa ndro Boes i. bstan, dzin phun tshogs. She! gong she! phreng. Dharamsala: Tibetan Medical and Astro Institute; 1994:537. 9. dGa' ba'i rdo rje. 'Khrung dpe dri med she/ gyi me long. Although based on the same medical texts, the knowl­ Beijing: Mi rigs dpe skrun kh ang; 1998:455. edge related to the many substances of mineral, animal, 10. Karma chos 'phel. bDud rrsi sman gyi 'khrungs dpe legs and plant origin of the Tibetan pharmacopeia may vary bshad nor bu'i phreng mdzes. Bod ljongs mi dmangs dpe according to the region, climate and vegetation, medical skrun khang, Lhasa; 1993. schools, local traditions, and foreign influences. Owing 11 . Cardi F. De l'approvisionnement des substances medicinales to the socio-economic, cultural, and political transforma­ a fa production des medicaments : /'evolution contemporaine de fa pharmacopee tibetaine [dissertation] . Universite tions of Tibetan societies, and to the standardization of de Ia Mediterranee, Faculte de Medecine de Marseille. medical knowledge and practice, it is important to docu­ 2004;345. ment this unique local knowledge that may disappear in 12. Boesi A. Le savoir botanique des Tibetains: perception, clas­ the near future. HG sification et exploitation des plantes sauvages [dissertation] .

46 I HerbaiGram 71 2006 www.herbalgram.org chu skyur (pronounced: ci u ghiur) Rheum alexandrae. Litang Coun ty (Sichuan, China), 4100 meters altitude, July 2000. Photo ©2006 Alessandro Boesi.

Unite d'Anthropologie et Adaptabilite Biologique, UMR Gyamtso. Vol 2. London: Serindia Publications; 1992:336. 6578, CNRS-Universite de Ia Mediterranee, Faculte de 14. Boesi A, Cardi F. The selection process ofTibetan materia Medecine de Marseille. 2004;324. medica: the approach of a practitioner in the region of 13. Parfionovich Y, Gyurme D, Meyer F. Tibetan medi­ Dhorpatan (Nepal). Rivista degli Studi Orientali. In press. cal paintings, illustrations of the Blue Beryl of Sangye 15 . Friedberg C. Classifications populaires des plantes et

Tibetan Medicinal Plant Conservation Airs on NPR's Morning Edition n February 21, 2006, NPR's Morning Edition teamed with a National Geographic Radio Expedition to China to describe the work of Jan Salick, PhD, an ethoobotanist from the Missouri Botanical Garden. Dr. Salick is part­ 0 nering with the Chinese Institute of Botany to study the problem of over-harvesting of mountain vegetation. The Chinese government hopes to develop a profitable pharmaceutical industry in the Yunnan province, but with a firm commitment to conservation to protect the source of potential new medicines. Many of these medicinal plants are threat­ ened both by global warming and by increasing global demand. Fortunately, conservation is a value already built into the Tibetan culture. Because plants are considered to be both medicinal and spiritual, large "sacred" sites are left untouched by modern life. Dr. Salick has found that useful, endemic plant species are much more common in these sacred sites than in surrounding ones. Traditional Tibetan doctors travel high into the mountains to collect medicinal plants for their patients. This local use does not affect plant populations signifi.candy, according to the NPR story. But the revival of Tibetan culture in China and the renewed interest in traditional medicine have created a growing international demand for these medicinal plants. More than half the species, nearly 6000 plants in the Yunnan province, are used for medicinal purposes and an estimated 4 billion people worldwide are buying them. HG -Nancy Dennis Source Arnold E. Sacred Protection for Medicinal Plants [transcript] . NPR Morning Edition. February 21, 2006. Available in audio at: http:// www.npr.org/templates/story/story.php?storyld=5222424. A written transcript of the NPR story can be obtained for $3.95 at http:// www.npr.org/transcripts.

www.herbalgram.org 2006 HerbaiGram 71 I 47 modes de connaissance. L'ordre et La diversite du vivant. QueL statu Additional literature scientifique pour Les cLassifications popuLaires< Pascal Tassy, ed. Pari s: Boesi A. Plant categories and types in Tibetan materia medica. The Tibet Foundation Diderot Fayard; 1986:21-49. journaL. 2006. In press. 16. Boesi A. Plant knowledge among T ibetan populations. In: A. Boesi Clifford T. The Diamond HeaLing, Tibetan Buddhist Medicine and Psychi­ & F. Cardi, eds. Wildli fe and plants in traditional and modern atry. New Delhi: Motilal Banarsiddass; 1994:268. Tibet: conceptions, exploitation, and conservation. Memorie deLLa Finckh E. Foundations ofTibetan Medicine. London: Watkins Publishing; Societa !taLiana di Scienze NaturaLi e deL Museo Civico di Storia 1978:80. NaturaLe di Milano. 2005;33(1 ):33-48. Anderson D , Sa li ck J, Moseley RK, Ou Xiaokun. Conserving the sacred 17. Zhengyi W, Raven PH , eds. FLora of China. Beijing: Science Press. medicine mountains: a vegetation analysis ofTibetan sacred sites in Sr. Louis: Missouri Botanical Garden Press; 1994. Northwest Yunnan. Biodiversity and Conservation. 2005;14:306-3091. 18. Boesi A, Cardi F. The variability ofTibetan materia medica and irs identification criteria: the case of Ladakh, India. Atti Soci­ eta itaLiana Scienze naturaLi Museo civico Storia naturaLe Milano 2003; 144(2):211-230.

Himalayan Snow Lotus Threatened with Extinction

igh in the Himalayas, well and are worth more money. above 12,000 feet, a cottony­ But when the larger plants are Hwhite flower called the Snow preferentially harvested, only Lotus grows on steep, unstable slopes. the smaller plants remain to Tibetans have traditionally used the sow seeds. The snow lotus blossoms to make medicine for high has lost nearly 4 inches in height in a hundred years,3 blood pressure and ailments associ­ which, according to Law and ated with pregnancy and menstrua­ his advisor, Jan Salik, PhD, tion.! Tourists prize it as an ornamen­ Curator of Ethnobotany tal souvenir because of its rarity and at the Missouri Botanical unusual appearance. Bags and boxes Garden, is fairly rapid evolu­ of dried snow lotus blossoms can be tionary change. 2 found in the markets of the Yunnan Because smaller snow lotus province where it is reportedly the plants may produce fewer biggest selling herb. 2 seeds than taller ones, human Graduate student Wayne Law preferences could be pushing has spent the last 4 years studying the snow lotus toward extinc­ the snow lotus through a National tion.4 Law and Salik hope to Science Foundation grant. Speaking to find out how much can be National Public Radio reporter Eliza­ harvested without threaten­ beth Arnold, Law described the snow ing the population. People lotus as existing in the most extreme have harvested only small conditions possible for plant life and amounts for use in tradi­ looking like it's wearing a big .fur tional Tibetan medicine, but jacket.2 the modern pressure of large Snow lotus (Saussurea spp., world markets now threatens Asteraceae) is an annual, monocar­ the snow lotus. The extinc­ pic plant (it flowers only once in its tion of this plant would Snow lotus Saussurea spp. Photo ©2006 Wayne Law. life) , with blooms lasting 3 to 4 weeks. represent not only a botanical A minimum of 7 years of vegetative loss but also a cultural loss as www.npr.org/templates/story/story. growth is required before the snow well. Documentation of the tradi- php?storyld=5222650. A written lotus will bloom. The plant is collected tiona! medicinal use of snow lotus can transcript of the NPR story can be only while flowering, when it has be found in the oldest Tibetan and obtained for $3.95 at http://www. reached its maximum size (W. Law e­ Chinese medicine books.2 HG npr.org!transcripts. 3. Gorman J. The Case of the Shrinking mail to C. Crimmons, February 28, -Nancy Dennis Lotus. The New York Tim es. July 5, 2006). Law has been closely watching References 2005;F:l. the particular species that is the most 4. Brahic C . Snow lotus could be prized, S. laniceps, and reports that 1. Ethnobotany: Saussure page. shrinking to extinction. Science in areas where harvesting has taken Missouri Botanical Garden Web site. and Development Nerwork Web place, he can barely find any flowering Available at: http://www.wlbcenter. site. Available at: http://www.scidev . plants. Also, the snow lotus plant itself org/saussurea.htm. Accessed June 13, net/News/index.cfm?fuseaction=prin 2006. has actually been decreasing in size tarticle&itemid=2203&1anguage= 1. 2. Arnold E. Saving the Snow Lotus Accessed April 6, 2006. because people tend to take the very from Extinction [transcript]. NPR biggest plants. The larger plants are Morning Edition. February 22, easier for collectors to see in the wild 2006. Available in audio at: http:/I

48 I HerbaiGram 71 2006 www. herbalgram.org NATURE'S TM ~ RESOURCE ® The # 1 broad Ii ne brand of herbs

Proud sponsor of For us, everyday is HerbDay! Improving the Quality of Reporting Randomized Controlled Trials Evaluating Herbal Interventions: Implementing the CONSORT Statement

by Joel J. Gagnier, NO, MSc, PhD (Candidate); Heather Boon, PhD; Paula Rochon, MD, MPH; David Moher, PhD; Joanne Barnes, PhD, MRPharmS, FLS; and Claire Bombardier, MD

Abstract ers, editors, and readers on the essential information required in reports of two-group parallel RCTs.3·4 The CONSORT ackground: Given that he~bal medicinal prod~cts are statement is endorsed by leading medical journals, editorial widely used, vary greatly m content and quality, and groups, professional societies, and funding bodies.5 Since its are actively tested in randomized controlled trials B inception, several extensions and context-specific applications (RCTs), such RCTs must clearly report the specifics of the of the CONSORT statement have been developed.6·7 This intervention. Our objective was to develop recommendations paper describes the application of the CONSORT checklist for reporting RCTs of herbal medicine interventions. to RCTs of herbal medicinal products.* Methods: We identified and invited potential participants Reports of controlled trials of herbal medicines must clearly with expertise in clinical trial methodology, clinical trial document all aspects of implementation, analysis, results, and reporting, pharmacognosy, herbal medicinal products, medi­ interpretation as recommended in the CONSORT State­ cal statistics, and/or herbal product manufacturing, to partic­ ment. Several studies suggest that reports of complementary ipate in phone calls and a consensus meeting. Three phases and alternative medicine (CAM) RCTs inadequately describe were conducted: (1) Pre-meeting item generation via phone important aspects of their methodology.8-12 For example, a calls, (2) Consensus meeting, and (3) Post-meeting feedback. sample of pediatric CAM RCTs reported less than 40% of Sixteen experts participated in pre-meeting phone calls for all necessary information outlined in the CONSORT check­ item generation, and 14 participants attended a consensus lisr.IO By comparison, RCTs of conventional medicine inter­ meeting in Toronto, Ontario, Canada, in June 2004. During ventions have been found to report between 40% and 60% the consensus meeting a modified Delphi technique was of the information outlined in the CONSORT checklisr.l3,l4 used to aid discussion and debate of information required for More specifically, one study showed that only 50% of CAM reporting RCTs of herbal medicines. trials reported how random numbers were generated and Results: After extensive discussion the group decided that 9 25% if allocation concealment was done.9 In herbal medicine CONSORT items needed elaboration for relevance to RCTs trials, only 28% of the reports described if the person admin­ of herbal medicines: Item 1 {Tide and Abstract), 2 {Back­ istering the intervention was blinded to group assignment or ground), 3 {Participants), 4 {Interventions), 6 {Outcomes), not, only 22% described the methods for implementing the 15 (Baseline data), 20 {Interpretation), 21 {Generalizability), allocation sequence, and just 21% the method for generating 22 {Overall evidence). the allocation sequence.11 Although the reporting quality of Discussion: The elaboration of Item 4 of the CONSORT herbal medicine trials appears to be improving, these trial statement outlines specific information required for complete reports are still missing important information. Of particular reporting of the herbal medicine intervention. The reporting importance is the reporting of the herbal intervention. suggestions presented will support clinical trialists, editors, and reviewers in reporting and reviewing RCTs of herbal medicines, and readers in interpreting the results. ' Herbal medicine: The term herbal medicine and herbal medicinal Background product will be used synonymously throughout this manuscript. (This paper was amhored by an international group. The term Randomized controlled trials (RCTs) provide the best "herbal dietary supplement," common in the United States, is evidence for efficacy of health-care interventions.! Low qual­ equivalent to the term "herbal medicine.") Herbal medicines ity reports of RCTs, compared to higher quality ones, exag­ include herbs, herbal materials, herbal preparations and finished gerate the estimates of a treatment's effectiveness. 2 Hence, herbal products that contain as active ingredients parts of plants, efforts have been made to improve the quality of report­ or other plant materials, or combinations used for medicinal ing.3.4 purposes and taken by ingestion, injection or applied topically. The Consolidated Standards of Reporting Trials This definition does not include single isolated compounds derived from plants, or compounds based upon specific constitu­ (CONSORT) statement was first published in 1996 and ents of plants. Source: General Guidelines for Methodologies on revised in 2001.3,4 This statement comprises a 22-item Research and Evaluation ofTraditional Medicine (WHO, WHO checklist and flow diagram to guide authors, peer review- MD; 2000; 80 pages) .

50 I HerbaiGram 71 2006 www.herbalgram.org Crude herbal drugs are natural products and their chemical 2 research assistants, the meeting coordinator {Joel Gagnier) and composition, therefore, varies depending on several factors, such meeting chair {Claire Bombardier) attended. The meeting began as geographical source of the plant material, climate in which it with a review of the pre-meeting item suggestions generated from was grown, time of harvest, and so on. It follows that commercially the phone calls. The meeting coordinator and chair emphasized available herbal medicinal products also vary in their content and the need to keep item extensions and additions to a minimum concentration of chemical constituents from batch-to-batch and, and that they be based on evidence, where possible. Participants when different products containing the same herbal ingredient are agreed that rather than adding items to the existing CONSORT compared, from manufacturer-to-manufacturer.lS-22 Even where checklist, several items required context-specific elaborations for herbal products are standardized for content of known active or relevance to herbal medicine interventions. marker compounds to achieve more consistent pharmaceutical We refined the suggestions using a modified Delphi technique.3° quality, there is variation in the concentrations of other poten­ Specifically, item suggestions were presented and followed by tially active constituents. Further, although there may be lack of debate and presentation of empirical evidence or common sense agreement and validation about some of the analytical methods reasoning for or against each. These were modified and deleted utilized, the true chemical content of some commercially available based upon these discussions and group consensus. The meeting herbal products has been demonstrated to be different from that took place over an evening session followed by a full day meeting stated on their labels. 20,23,24 These variations can result in differ­ of the assembled group. Within 8 weeks of the consensus meet­ ences in pharmacological activity in vitro25 and in bioavailability ing, a draft report was circulated to all participants to ensure that in humans, 26 which is of clinical relevance. Quantitative and qual­ the report accurately represented the decisions made during the itative variations in the content of herbal medicinal products are consensus meeting. The manuscript was then circulated to the not limited to active or otherwise desirable constituents; variation wider CONSORT Group for their input. The report was revised in concentrations of toxic constituents has also been reported. 27 in light of these suggestions. For these reasons, it should not be assumed that the results of an RCT of a particular herbal intervention {e.g., an extract of Results Ginkgo biioba leaf standardized to contain 24% ginkgo flavonol Rather than adding new items to the CONSORT statement, glycosides) can be generalized to all products containing or made the group decided that 9 existing CONSORT items needed elabo­ from the same herb {e.g., all Ginkgo biioba products). Therefore, ration for relevance to RCTs of herbal medicine intervention. The it is imperative that reports of RCTs of herbal medicine interven­ recommendations are listed in Tables 1 and 2 and are intended to tions provide clear and complete descriptions of the intervention, be used in conjunction with the 22 existing CONSORT items. i.e., of the herbal material and/or preparation.28-29 Against this In Table 1, CONSORT items appear in normal text and recom­ background, our objective was to develop reporting recommen­ mendations for reporting RCTs of herbal medicine in italicized dations for RCTs of herbal medicine interventions by elaborating text. Table 2 contains a detailed outline of recommendations for upon the 22-item checklist of the CONSORT statement to guide reporting the herbal medicine intervention, an elaboration upon authors, peer reviewers, and editors on appropriate reporting for CONSORT item 4. such studies. Here, we present recommendations regarding the CONSORT items requiring specific elaboration for relevance checklist items for herbal interventions; further explanations and to RCTs of herbal medicine interventions were {see Tables 1 and examples of good reporting will be published separately. 2): Item 1 (Title and Abstract), 2 (Background), 3 (Participants), 4 {Interventions), 6 (Outcomes), 15 {Baseline data), 20 {Interpre­ Methods tation), 21 {Generalizability), 22 {Overall evidence). The process used to develop the reporting recommendations for RCTs of herbal medicine interventions consisted of 3 phases: Recommendations (1) Pre-meeting item generation, (2) Consensus meeting, and (3) The tide and/or abstract (Item 1) should include the Latin bino­ Post-meeting feedback. We identified and invited potential partic­ mial for the plant species from which the herbal medicine(s) origi­ ipants based on their international reputations and peer-reviewed nated, the part(s) of the plant used in the preparation, and the publications with expertise in clinical trial methodology and/or type of preparation (e.g., dried crude herb, ethanolic extract). The reporting {n=5), pharmacognosy (n=4), herbal medicinal prod­ background {Item 2) should include a statement explaining the ucts (n=5), medical statistics {n= 1), and herbal product manufac­ rationale for investigation of the specific herbal medicinal product turing {n= 1). Individuals who agreed to participate were mailed a and whether the indication for which it is being tested is new or is selection of articles on herbal medicine interventions and report­ based on traditional use. Participant eligibility criteria {Item 3) in ing quality. During May and June of 2004, 16 participants were a trial testing a traditional indication (e.g., in traditional Chinese contacted by telephone by one investigator {Joel Gagnier) and herbal medicine, a trial may test the effects of an herbal medicine asked to suggest necessary revisions to existing CONSORT items intervention for liver chi (Qi) deficiency) should describe the theo­ and additional/new items required for reporting herbal medi­ ries and concepts underlying this indication. cine RCTs. Participants were asked to consider items based upon The description of the intervention {Item 4; Table 2) must empirical evidence that not reporting them would bias the esti­ include the herbal medicinal product name, manufacturer, plant mates of treatment effect. Where no empirical evidence was avail­ part used, type of preparation, source and authentication of the able, common sense reasoning was acceptable. When all phone herbal material, pharmaceutical quality (e.g., herbal drug-to­ calls were completed, one individual {Joel Gagnier) thematically extract ratio, type and concentration of the extraction solvent, grouped items and circulated them for review by each partici­ quantity of known active constituents per unit dose), and dosage pant. regimen and qualitative testing (purity). Also, reporting of the The second phase took place in Toronto, Ontario, Canada rationale for the control/placebo used in the trial is recommended. on June 28 and 29, 2004, and was attended by 14 individuals For studies involving herbal medicine practitioners as part of the from various countries including: Canada (n=7), England (n=3), intervention, details of practitioners (e.g., training, registration United States (n=2), India (n= 1), and Germany (n= 1). In addition, status) should be reported. Not all recommendations are rele-

www.herbalgram.org 2006 HerbaiGram 71 I 51 vant for all types of herbal medicine interventions. T herefore, we an overview of evidence on this particular herbal medicinal prod­ begin this section with the words "where applicable." For example, uct. W hen considering generali za bility (Item 21), it is suggested a report of an RCT of an herbal medicinal product comprising that authors report how the product used in the trial ge neralizes crude herbal material (e.g., leaves, stems, root) prepared as a tea to products used in self-care and/or in clinical practice. Finally, or decoction does not require reporting of the "type and concen­ when interpreting the res ults in the context of the evidence (Item tration of solvent used and the plant to plant extract ratio" (Table 22), it is recommended that a general discussion in relation to 2, Item 4.8.3.). In addition, herbal interventions made by the trials of other available products should be reported. investigators specifica lly for the study will not have a finished product or extract name or manufacturer (Table 2, Item 4.A.2.). Discussion For such products, all methods used in preparing and formulat­ The CONSORT Statement outlines information required in ing the product must be reported. Similarly, item 4.F. (Table 2) is reports of any 2-group parallel RCT design.! We have developed only relevant for studies in which the practitioner is a part of the and described recommendations (see Tables 1 and 2) to be used intervention. In other studies, the practitioner may serve a more in conjunction with the existing CONSORT checklist when neutral role and thus their characteristics need not be reported. reporting RCTs of herbal medicine interventions. These recom­ With these exceptions, all information outlined in these recom­ mendations were developed to guide clinical trialists, editors, and mendations are suggested to be reported for all herbal medicine reviewers in reporting and reviewing RCTs of herbal medicine interventions. interventions. Beyond RCTs, these recommendations are rele­ Also, outcome measures (Item 6) should reflect the intervention vant for reporting herbal interventions in other research designs, and indications tested while considering their underlying theories whether preclinical (e.g., in vivo, in vitro) or clinical (e.g., N of and concepts. For the results section, it is recommended that in 1 trials). addition to other baseline data (Item 15), RCTs of herbal medicine T he type of information required for a complete description interventions report any concomitant medication, herbal medici­ of any intervention is relative to the type of intervention being nal product, or other CAM use. It is recommended that when tested. For trials of surgical interventions, for example, a complete interpreting the results (Item 20) there be consideration of the description of the individual performing the surgery may be specific herbal product and dosage regimen tested. This includes required. I For controlled trials of herbal medicines, the in forma-

Table 1: Proposed Elaborations of CONSORT Items for Randomized Controlled Trials of Herbal Medicine Interventions* Standard CONSORT Standard Descriptor checklist: Paper CONSORT Section and Topic checklist: Item TITLE & ABSTRACT 1 How participants were allocated to interventions (e.g., "random allocation;"'randomized" or "randomly assigned"). Either the title, abstract, or both should state the herbal medicinal product's Latin binomial, the part of the plant used, and the type of preparation. INTRODUCTION 2 Scientific background and explanation of the rationale. Background Including a brief statement of reasons for the trial with reference to the specific herbal medicinal product being tested and, if applicable, whether new or traditional indications are being investigated. METHODS 3 Eligibility criteria fo r participants and the settings and locations where the data were collected. Participants If a traditional indication is being tested, a description of how the traditional theories and concepts were maintained. For example, participant inclusion criteria should reflect the theories and concepts underlying the traditional indication. Interventions 4 Precise details of the interventions intended for each group and how and when they were actually administered. A detailed description of this item appears in Table 2. Objectives 5 Specific objectives and hypotheses. Outcomes 6 Clearly defined primary and secondary outcome measures and, when applicable, any methods used to enhance the quality of measurements (e.g., multiple observations, training of assessors). Outcome measures should reflect the intervention and indications tested considering, where applicable, underlying theories and concepts. Sample size 7 How sample size was determined and, when applicable, explanation of any interim analyses and stop- ping rules. Randomization 8 Method used to generate the random allocation sequence, including details of any restriction (e.g., Sequence blocking, stratification). allocation Allocation 9 Method used to implement the random allocation sequence (e.g., numbered containers or central tele- concealment phone). clarifying whether the sequence was concealed until interventions were assigned. Implementation 10 Who generated the allocation sequence, who enrolled participants, and who assigned participants to their groups. *CONSORT items 1A are listed in normal text. Proposed implementations for relevance to reports of herbal medicine RCTs are listed in italicized text.

52 I HerbaiGram 71 2006 www.herbalgram .org tion recommended when reporting the herbal intervention {Item that there has been a significant increase in the quality of repo rts 4; Table 2) is essential to provide a complete description of the of RCTs in journals that endorse it, recognizing that this might herbal product being tested. There is a wide variety of commer­ not translate into journal adherence_32,33 In an effort to evaluate cially available products containing herbal medicines. Unfor­ the impact of the recommendations for reporting herbal medicine tunately, there is great variability in the content of these prod­ interventions, we plan to evaluate their influence on the report­ ucts.IS-24 Products may not contain the amount (weight, volume, ing of herbal medicine RCTs. To suppo rt this initiative we invite proportion) of individual constiruems listed o n their labels31 or journal editors to include a reference to these recommendarions34 any of the constituents at all. Also, products containing the same or a copy of the checklist (www.ww.annals.org) in their journal's bota nical species often contain varying amounts of the plant's instructions to authors as this w ill likely support the improvement marker/activet constituents.19,20 A thorough description of the of reporting of RCTs of herbal medicine interventions. product will allow for the valid and reliable determination of effi­ In a n effort to keep the checklist evidence based, incorpo rat­ cacy and safety of specific herbal products. ing emerging data, and up to date, we will periodically update Since publication of the CONSORT Statement, data suggest the recommendations. The goal is improved reporting, which ultimately will support clear interpretatio n of trial methods and results, improving the validity of inferences derived from trial t Active constituent(s): Those compounds that are proposed to be respon­ findings.35-36 sible for the therapeutic effect attributed to the herbal ingredient or In addition to this overview, an explanatory document has product. T his may be a single constituent or a group or groups of been produced that describes each recommendation in derail and constituents. A marker compound, or group of marker compounds, is provides examples of good reporting and empirical evidence for a plant constituent that may be used as a proxy measuremenr roo! fo r individual items where available)? the full spectrum of compounds in the botanical product. This can be Joel J. Gagnier, NO, MSc, PhD (Candidate) a single compound or compounds that usually represent a group of Address: Ontario St, U n it W indsor, O nta rio, constituents. Marker compounds are generally intended as in-process 5955 307, manufacturing controls and are generally unreliable as indicators of Canada, N8SlW6. Position: Post-G raduate Fellow, D epartment identiry. of Health Policy, M anagement and Evaluatio n, D epartment of Medicine, University of Toronto, Toronto, Ontario, Canada.

Table 1: Proposed Elaborations of CONSORT Items for Randomized Controlled Trials of Herbal Medicine Interventions* Standard CONSORT Standard Descriptor checklist: Paper CONSORT Section and Topic checklist: Item Blinding (Masking) 11 Whether or not participants, those administering the interventions, and those assessing the outcomes were blinded to group assignment. When relevant, how the success of b li nding was evaluated. Statistical 12 Statistical methods used to compare groups for primary outcome(s); Methods for additional analyses, methods such as subgroup analyses and adjusted analyses. RESULTS 13 Flow of participants through each stage (a diagram is strongly recommended). Specifically, fo r each Participant flow group, re port the number of participants randomly assigned, receiving intended treatment, complet- ing the study protocol, and analyzed for the primary o utcome. Describe protocol deviations from study as planned, together with reasons. Recruitment 14 Dates defining the periods of recruitme nt and follow-up. Baseline data 15 Baseline demographic and clinical characteristics of each group. Including concomitant medication, herbal and complementary medicine use. Numbers analyzed 16 Number of participants (denominator) in each group included in each analysis and whether the analy- sis was by "intention-to-treat:' State the results in absolute numbers when feasible (e.g., 10/20, not 50%). Outcomes and 17 For each prima ry and secondary outcome, a summary of results for each group, and the estimated Estimation effect size and its precision (e.g., 95% confidence interval). Ancillary analyses 18 Address multiplicity by reporting any other analyses performed, including subgro up analyses and adjusted analyses, indicating those pre-specified and those exploratory. Adverse events 19 All important adverse events or side effects in each intervention group. DISCUSSION 20 Interpretation of results, taking into account study hypotheses, sources of potential bias or impreci- Interpretation sion, and the dangers associated with multiplicity of analyses and outcomes. Interpretation of the results in light of the product and dosage regimen used. Generalizability 21 Generalizability (external validity) of trial results. Where possible, discuss how the herbal product and dosage regimen used relate to what is used in self-care and/ or practice. Overall evidence 22 General interpretation of the results in the context of current evidence. Discussion of the trial results in relation to trials of other available products. *CONSORT items1·4 are li sted in normal text. Proposed implementations for relevance to reports of herbal medici ne RCTs are listed in italicized text.

www.herbalgram.org 2006 HerbaiGram 71 I 53 Heather Boon, PhD Address: Leslie Dan Faculty of Pharmacy, 19 Russell Street, University of Toronto, Toronto, Ontario, Canada, M5S 2S2. Position: Assistant Professor. Paula Rochon, MD, MPH Address: Baycrest Centre for Geriatric Care 3560 Bathurst Street, Toronto, Ontario, Canada, M6A 2El. Position: Asso­ ciate Professor, Department of Health Policy, Management and Evaluation, Department of Medicine, University of Toronto; Scientist, Institute for Clinical Evaluative Sciences; Scientist, Kunin-Lunenfeld Applied Research Unit, Toronto, Ontario, Canada. David Moher, PhD Address: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Rm. 210, Ottawa, Ontario, Canada, KlH 8Ll. Position: Associate Professor, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Joanne Barnes, PhD, MRPharmS, FLS Address: Centre for Pharmacognosy & Phytotherapy, School of Pharmacy, 29/39 Brunswick Square, University of London, London, United Kingdom, WClN lAX. Position: Lecturer in Phytopharmacy. Claire Bombardier, MD Address: Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, Ontario, Canada, M5G 2E9. Position: Professor, Department of H ealth Policy, Manage­ ment and Evaluation, Department of Medicine, University of Toronto; Canada Research Chair in Knowledge Transfer for Musculoskeletal Care; Director, Health Care Research and Clinical Decision Making, Toronto General Research Insti­ tute; Clinical Research Coordinator, Institute for Work & H ealth, Toronto, Ontario, Canada. D etails of contributors: Joel Gagnier NO, MSc, PhD (Candidate), conceptual­ ized the study design, identified and secured funding, iden­ tified and invited participants, coordinated the consensus meeting and phone calls, wrote, edited, and revised the Visit www.camexpo.com to register manuscript. Heather Boon, PhD, conceptualized the study today or for more information! design, identified and secured funding, identified and invited participants, and edited and commented upon the manuscript. Paula Rochon, MD, MPH, conceptualized the CAMEXPO West study design, identified and secured funding, and edited Conference: November 10-12, 2006 and commented upon the manuscript. David Moher, PhD, Exhibits: November 11-12, 2006 conceptualized the study design, identified and invited Los Angeles, CA participants, and edited and commented upon the manu­ script. Joanne Barnes edited and commented upon the Hyatt Regency Century Plaza manuscript. Claire Bombardier, MD, conceptualized the study design, identified and secured funding, identified and Improve Patient Care. invited participants and, and edited and commented upon the manuscript. Get the most up-to-date, credible, Details of ethical approval: Ethical approval was acquired leading-edge information from the University of Toronto H ealth Sciences Ethics from top-notch industry experts including: Review Committee, obtained on January 23, 2004. Jeffrey S. Bland, PhD, FACN, CNS; Tieraona Low Dog, MD; Details of funding: This study was funded in part by James S. Gordon, MD; Christiane Northrup, MD; an operating grant from the Canadian Institutes of Health Frank Lipman, MD; Diana Schwarzbein, MD; Hyla Cass, MD; Research, Clinical Trials Divisions; Grant number: ATF- Randall Neustaedter, OMD, LAc, CCH; Lawrence Rosen, MD, 66679. Dr. Gagnier is supported by a post-graduate fellow­ and other CAM professionals. ship from the Canadian Institutes of Health Research and the Natural Health Products Directorate. Featuring: The 9th Wodd <::on,.... oo l'rotiuaNiby: Statement of independence of researchers from funders: Qigong diversified _. Tmlt!onal Chlneoe Medicine All researchers are independent of the funders. CODE: 9508

54 I HerbaiGram 71 2006 www.herbalgram.org Focus group participants Faculty of Medicine, University of Toronto); Gary Leong, MBA The individuals listed below participated in the pre-meeting (Jamieson Vitamins Inc., Windsor, Ontario, Canada); Allison phone calls or attended the consensus meeting and provided input McCutcheon, PhD (Faculty of Pharmaceutical Sciences, Univer­ towards the elaborations to existing CONSORT items. sity of British Columbia, British Columbia, Canada); David Doug Altman, D Phil (Cancer Research UK Medical Statistics Moher, PhD (Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada); Max H . Pittler, MD (Complemen­ Group, Centre for Statistics in Medicine, Oxford, UK); Joanne Barnes, PhD (Centre for Pharmacognosy and Phytotherapy, The tary Medicine, Peninsula Medical School, University of Exeter, School of Pharmacy, University ofLondon, London, UK); C laire Exeter, United Kingdom); David Riley, MD (University of New Bombardier, MD - Meeting Chair (Department of Health Policy Mexico Medical School, Santa Fe, New Mexico, USA); Paula Rochon, MD, MPH (Baycrest Centre, Toronto, Ontario, Canada); Management and Evaluation, Faculty of Medicine, University of Toronto); Heather Boon, PhD (Leslie Dan Faculty of Pharmacy, Michael Smith, MRPharm, NO (Health Canada, Natural H ealth University of Toronto, Canada); Mark Blumenthal (American Products Directorate, Ottawa, Ontario, Canada); Andrew Vickers Botanical Council, Austin, TX, USA); Ranjit Roy Chaudhury, PhD (Memorial Sloan-Kettering Regional Cancer Centre, New PhD (Chair INCLEN Inc., India); Philip Devereaux, MD, York, NY, USA). PhD (Department of Clinical Epidemiology and Biostatistics, The members of the CONSORT Group are listed on the Faculty of Health Sciences, McMaster University, Hamilton, ON, following website: http:/ /www.consort-statement.org/profiles/ Canada); Theo Dingermann, PhD (Institute for Pharmaceutical partners.html. HG Biology Biozentrum, University of Frankfurt/Main, Germany); Acknowledgements Joel Gagnier NO, MSc, PhD (Candidate) - Meeting Coordina­ tor (Department of Health Policy Management and Evaluation, The authors would like to thank Greer Palloo for aiding in the

Table 2: Proposed Elaboration of CONSORT Item 4 for Reporting Randomized Controlled Trials of Herbal Medicine Interventions Standard Standard Descriptor CONSORT check- CONSORT list: Paper Section checklist: Item and Topic METHODS 4. Where applicable, the description of an herbal intervention should include: Interventions 4.A. 1. The Latin binomial name together with botanical authority and family name for each herbal Herbal medici- ingredient; common name(s) should also be included. nal product 2. The proprietary product name (i.e. brand name) or the extract name (e.g., EGb-761) and the name name of the manufacturer of the product. 3. Whether the product used is authorized (licensed, registered) in the country in which the study was conducted. 4.B. Charac- 1. The part(s) of plant used to produce the product or extract. teristics of the 2. The type of product used [e.g. raw (fresh or dry), extract). herbal product 3. The type and concentration of extraction solvent used (e.g., 80% ethanol, H20 100%, 90% glycer- ine, etc.) and the herbal drug to extract ratio (drug:extract; e.g., 2:1). 4. The method of authentication of raw material (i.e., how done and by whom) and the lot number of the raw material. State if a voucher specimen (i.e., retention sample) was retained and, if so, where it is kept or deposited, and the reference number. 4.C. 1. The dosage of the product, the duration of administration, and how these were determined. Dosage regi- 2. The content (e.g., as weight, concentration; may be given as range where appropriate) of all men and quan- quantified herbal product constituents, both native and added, per dosage unit form. titative descrip- Added materials, such as binders, fillers, and other excipients; e.g., 17% maltodextrin, 3% silicon tion dioxide per capsule, should also be listed). 3. For standardized products, the quantity of active/marker constituents per dosage unit form. 4.0. 1. Product's chemical fingerprint and methods used (equipment and chemical reference standards) Qualitative test- and who performed it (e.g., the name of the laboratory used). Whether or not a sample of the prod- ing uct (i.e., retention sample) was retained and if so, where it is kept or deposited. 2. Description of any special testing/purity testing (e.g., heavy metal or other contaminant testing) undertaken. Which unwanted components were removed and how (i.e., methods). 3. Standardization: what to (e.g., which chemical component(s) of the product) and how (e.g., chemical processes, or biological/functional measures of activity). 4.E. The rationale for the type of control/placebo used. Placebo/control group 4.F. A description of the practitioners (e.g., training and practice experience) that are a part of the inter- Practitioner vention.

www.herbalgram.org 2006 HerbaiGram 71 I 55 preparation for the June meeting and Jaime DeMelo and Cyndi Pharm. 2002;59(16): 1527-1531. Gilberr for assisting Joel Gagnier and Claire Bombardier during 19. Manning J, Roberts JC. Analysis of catechin content of commercial the actual meeting procedures. green rea products. j Herb Pharmacother. 2003;3(3): 19-32. 20. Carlson M, Thompson RD. Liquid chromatographic determination Financial suppon for the project was provided by the C linical of merhylxanthines and catechins in herbal preparations containing Trials Division at the Canadian Institutes of Health Research. guarana.] AOAC Int. 1998;81(4):691-701. Grant number: ATF-66679 21. Haller CA, Duan M, Benowitz Nl, Jacob P. Concentrations of Ephedra alkaloids and caffeine in commercial dietary supplements. References J Anal Toxicol. 2004;28(3):145-1 51. I. Altman DG, Schulz KF, Moher D for the CONSORT Group. The 22. Kressmann S, Muller WE, Blume HH. Pharmaceutical qual­ revised consort statement for reporting randomized trials: Explana­ ity of different Ginkgo biloba brands. J Pharm Pharmacal. tion and elaboration. Annals ofInt ernal Medicine. 2001; 134(8):663- 2002;54(5): 661-669 94. 23. Gurley BJ , Gardner SF, Hubbard MA. Content versus label claims 2. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical in ephedra-contain ing dietary supplements. Am J Health-Syst evidence of bias: Dimensions of methodological quality associa­ Pharm. 2000;57:963-969. ted with estimates of treatment effects in controlled trials. JAMA. 24. De Los Reyes GC, Koda RT. Determining hyperforin and hypericin 1995;273:408-412. content in eight brands of St. John's wort. Am J Health Syst Pharm. 3. Begg CB, Cho MK, Eastwood S, et al. Improving the quality of 2002;59(6):545-547. reporting of randomized controll ed trials: The CONSORT state­ 25. Schulte-Lobbert S, Holloubek G, Muller WE, Schubert-Zsilavecz ment. JAMA. 1996;76(8):637-639. M, Wurglics M. Comparison of the synapotosomal uptake inhibi­ 4. Moher D, Schulz KF, Altman D for the CONSORT Group tion of serotonin by St. John's worr products. J Pharm Pharmacal. (Consolidated Standards of Reporting Trials) . The CONSORT 2004;56(6) :813-818. statement: revised recommendations for improving the quality of 26. Kressmann S, Biber A, Wonnemann M, Schug B, Blume HH, reports of parallel-group randomized trials. JAMA. 2001 ;285: 1987- Muller WE. Influence of pharmaceutical quality on the bioavailabi­ 1991. li ty of active components from Ginkgo biloba preparations. j Pharm 5. Moher D, Airman DG, Schulz KF, Elbourne DR, for the Pharmacal. 2002;54(1 1):1 507-1514. CONSORT Group. Opportunities and challenges for improving 27. Oberlies NH, Kim NC, Brine DR, er al. Analysis of herbal teas the quality of reporting clinical resea rch: CONSORT and beyond. made from the leaves of comfrey (Symphytum officina/e): reduction Canadian Medical Association journa/2004; 17 1:349-350. of N-Oxides results in order of magnitude increases in the measu­ 6. Campbell MK, Elbourne DR, Altman DG for the CONSORT rable concentration of pyrrolizidine alkaloids. Public Health Nutr. Group. CONSORT statement: extension to cluster randomized 2004;7(7):919-924. trials. BMJ. 2004;328:702-708. 28. Barnes J. Pharmacovigilance of herbal medicines. A UK perspective. 7. Joannidis JPA, Evans S, Gotzsche PC, O'Neill RT, Altman DG, Drug Saftty. 2003;26(12):829-851. Schulz KF, Moher D, for the CONSORT Group. Better Reporting 29. Linde K & Willich SN. How objective are systematic reviews? of Harms in randomized trials: An extension of the CONSORT Differences between reviews on complementary medicine. J Royal Statement. Annals ofI nternal Medicine. 2004; 141 (I 0):781-788. Soc Med. 2003;96: 17-22. 8. Little C, Parsons T. Herbal therapy for treating rheumatoid arthri­ 30. Bowling A. Resea rch methods in health (2nd ed). Maidenhead, UK: tis. Cochrane Library. 2000;4. Open University Press, 2002. 9. Linde K, Jonas WB, Melchart D, Willich S. The methodologi­ 31. Manning J, Roberts JC. Analysis of catechin content of commercial cal quality of randomized controlled trials of homeopathy, herbal green rea products. j Herb Pharmacother. 2003;3(3): 19-32. medicines and acupuncture. International journal ofEpidemiology. 32. Moher D, Jones A, Lepage L; CONSORT G roup. Use of the 2001 ;30:526-531. CONSORT statement and quali ty of reports of randomi­ 10. Moher D, Sampson M, Campbell K, Beckner W, Lepage L, zed trials: a comparative before-and-after evaluation. JAMA. Gaboury I, Berman B. Assessing the quality of reports of random­ 200 1;285(15): 1992-1995. ized trials in pediatric and complementary and alternative medicine. 33. Devereaux PJ , Manns BJ , Ghali WA, Quan H, Guyatt GH. The BMC Pediatrics. 2002;2. reporting of methodological factors in randomized controlled trials 11 . Gagnier JJ , DeMelo J, Boon H, Rochon P, Bombardier C. Quality and the association with a journal policy to promote ad herence of reports of randomized controlled intervention trials of botanical to the Consolidated Standards of Reporting Trials (CONSORT) medicines. In Press. checklist. I. 2002;23:380-388. 12. Klasse n TP, Pham B, Lawson ML, Moher D. The quality of reports 34. Gagnier JJ, Boon H, Rochon P, Barnes J, Moher D, Bombardier of complementary and alternative medicine randomized controlled CB for the CONSORT Group. Reporting randomized controlled trials is as good as conventional medicine reports of randomized trials of herbal interventions: an elaborated CONSORT statement. controlled trials. J Clin Epi. 2004. In Press. Ann Int Med. March 7, 2006. 13. Huwiler-Muntener K, Juni P, Junker C, Egger M. Quality of 35. Srreiner DL, Norman GL. Health Measurement Scales: A practical reporting of randomized trials as a measure of merhodologic quality. guide to their use and development. Oxford Medical Publication: JAMA. 2002;287(21):280 1-2804. Oxford; 2001. 14. Moher D, Jones A, Lepage L for the CONSORT Group. Use 36. Gagnier JJ, Boon H , Rochon P, Barnes J, Moher D, Bombardier of the CONSORT statement and quality of reports of random­ CB for the CONSORT Group. Reporting randomized controlled ized trials: A comparative before and after evaluation. JAMA. trials of herbal interventions: an elaborated CONSORT statement. 2001 ;285(15): 1992-1995. Explore: The Journal ofScience ofHealing. 2006;2:2. 15. Harkey MR, Henderson, GL, Gershwin, ME, Stern, JS , Hackman, 37. Gagnier JJ , Boon H , Rochon P, Barnes, J, Moher D, Bombardier RM. Variability in commercial Ginseng products: an analysis of 25 CB for the CONSORT Group. CONSORT extension to randomi­ preparations. Am J Clin Nutr. 2002;75(3):600-601. zed controlled trials of herbal medicinal products: Explanation and 16. Groenewegen WA, Heptinsrall S. Amounts of feverfew in commer­ implementation. J Clin. Epi. March 2006. In Press. cial preparations of rhe herb. Lancet. 1986; 1:44-5. 17. Heptinsrall S, Awang DV, Dawson BA et al. Parthenolide content and bioactivity of feverfew (Tanacetum parthenium [L. ] Schulrz­ Bip.). Estimation of commercial and authenticated feverfew prod­ ucts. j Pharm Pharmacal. 1992; 44:391-395. 18. Nelson MH, Cobb SE, Shelton J. Variations in parthenolide content and daily dose of feverfew products. Am J Health-Syst

56 I Herba\Gram 71 2006 www.herbalgram.org where Nature and Science come together

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WHO Surveys Worldwide Patterns of Herbal Regulations by Courtney Cavaliere

he results of a global survey, released in May 2005 by the World Health Organization (WHO), indicate that many countries have made recent progress in the development and implementation of regulations on herbal medicinal products.l WHO's T National Policy on Traditional Medicine and Regulation of Herbal Medicines: Report ofa WHO Global Survey provides informa­ tion on the status of herbal regulations and laws worldwide, as well as the state of national policies on traditional, complementary, and alternative medicines.

WHO distributed its Global Survey The most commonly utilized regula­ tions. The majority of respondents (73%, questionnaire in 2002 to national health tory status for herbal medicines is that of or 103 countries) indicated that they allow authorities of the 191 countries serv­ over-the-counter medications, according the use of claims in the sale of herbal ing as WHO's member states at that to data from respondents. This status is medicines. Of the 103 countries allow­ time. Survey responses were returned by reportedly used within 97 of the coun­ ing claims, the majority identified medi­ 142 countries-a response rate of 74%. tries who responded to the survey. Other cal claims and health claims as those According to the Executive Summary of commonly-cited methods of regulating most commonly utilized. The authors of the report, only 14 of WHO's member herbal medicines are as prescription medi­ the report stipulated, however, that exact states had regulations relating to herbal cations (50 countries), dietary supple- figures of claim usage seem unreliable, due to problems with the wording and/or interpretation of the question. Member States with National Policies and Those Pending Only 24% of countries (34 coun­ tries) indicated the existence and use of a national pharmacopeia. Of the 104 countries without such a document, 25% (26 countries) claimed that a (national or regional) pharmacopeia is in develop­ ment, and 56% (58 countries) responded that another (external) pharmacopeia is in use. A similarly small percentage of countries (33%, or 46 countries) claimed to have national monographs. Of the 84 countries lacking national monographs, 28% (25 countries) indicated mono­ graphs were being prepared and 38% (34 countries) claimed to use other mono­ graphs from other sources. Twenty-seven countries without national monographs provided data as to the other mono­ Answer pending Ill No Answer II No policy 0 No survey graphs utilized, some indicating the use of multiple compendia. The most commonly Sou rce: National Policy on Traditional Medicine and Regulation of Herbal Medicines: Report of a WHO selected international monographs were Global Survey. those prepared by WHO (12 countries), followed by the European Pharmacopoeia medicine before 1988, but the number ments (47 countries), self-medication only (8 countries), ESCOP (European Scien­ had increased to 53 member states (37%) products (40 countries), separate herbal­ tific Cooperative on Phytotherapy) mono­ by 2003.2 Of those countries without such specific categories (25 countries), health graphs (4 countries), German Commis­ laws and regulations, 42 (49%) claimed foods (15 countries), and functional foods sion E Monographs (3 countries), and herbal regulations were in the process of {9 countries). Respondents were allowed the British Pharmacopoeia (3 countries). being developed. According to Figure to choose multiple categories if more than Twelve countries indicated use of other 12 of the report, however, the major­ one status was in effect; hence, the total sources for monographs. Of the 46 coun­ ity of responding countries (92, or 65%) of tallies for each of the categories (283) tries with national monographs, 52% (24 claimed to have laws or regulations on exceeds the number of countries partici­ countries) identified them as being legally herbal medicines.1 Information from 77 of pating in the survey. Twenty-three coun­ binding; of the 34 countries using other those countries further indicates that such tries claimed to have no regulatory status monographs, 44% (15 countries) reported laws and regulations were either issued for herbs. those texts as legally binding. without any indication of when they were The survey further inquired about the Data regarding manufacturing regu­ issued or have only recently been enacted, types of claims applicable to herbal medi­ lations and safety assessment of herbal particularly within the last 15 years. cines under countries' laws and regula- medicines was also collected through the

58 I HerbaiGram 71 2006 www.herbalg ram.org L gal &Regulatory 1------

global survey. Questions about manufac­ requirements as pharmaceuticals, and 28 ias. Much of this information has not turing requirements were answered by countries answered that they have no been translated into English, and access 126 countries, and these countries were safety requirements. Further, 59 of 114 to the database is presently limited to allowed to select more than one response. responding countries indicated the exis­ national health authorities. WHO intends The majority of respondents (73 coun­ tence of a post-marketing surveillance to continually update the database's infor­ tries) claimed that the same rules of good system for herbal medicines. Of those mation. HG manufacturing practices (GMPs) required 59 countries, 53 (or 90%) also claimed for conventional medicines are enforced to have a national system to monitor References for herbal medications. Fifty-nine coun­ adverse effects. Forty-four of the 77 coun­ I. World Health Organization. National tries indicated that they are required to tries without post-marketing surveillance policy on traditional medicine and regu­ adhere to the criteria, requirements and systems reported that such systems were lation ofherbal medicines: report ofa WHO global survey. Geneva: World other related information specified in under development. Health Organization; 2005. Available pharmacopeias and official monographs, Other topics addressed within the report at: hnp://whqlibdoc.who. int/publica­ and 30 countries indicated that they use include registration systems for herbal tions/2005/9241593237.pdf Accessed special GMP rules. Twenty-eight coun­ medicines, herbs on essential drug lists, April 27, 2006. tries claimed to have no manufacturing sales of herbal medicines, and difficulties 2. World Health Organization. Executive requirements for herbal medicines. countries face in regards to herbal regu­ Summary: National policy on traditional Safety assessment questions, mean­ lation. Using data obtained through the medicine and regulation ofherbal medi­ while, were answered by 130 countries. survey, WHO developed a global database cines: report ofa WHO global survey. Geneva: World Heal th Organization; Again, respondents were allowed to make regarding countries' herbal regulations and 2005:iii-vii. multiple choices. The majority of coun­ policies regarding traditional medicine or tries (82) claimed to use special require­ complementary and alternative medicine. ments for safety assessment-including The database contains all responses to the the requirement of traditional use without questionnaire, as well as detailed infor­ demonstrated harmful effects, or refer­ mation on individual countries' laws and ences to scientific research. Fifty-seven regulations, further regulatory require­ countries claimed to use the same safety ments, monographs, and pharmacope-

www.herbalgram.org 2006 HerbaiGram 71 I 59 Legal &Regulatory

Australian TGA Publishes Liver Warning Policy for Black Cohosh by Mark Blumenthal n February 2006 the Australian Therapeutic Goods Administration (TGA) issued a policy for a new label warning to be required for all herbal products containing black cohosh (Actaea racemosa L. Ranunculaceae, syn. Cimicifuga racemosa). 1 TGA cited at least I 47 adverse event reports (AERs) of hepatotoxicity collected worldwide that have been allegedly associated with black cohosh­ containing products. Even though some of these products have contained multiple herbs, some observers have classed them as black cohosh-related AERs.

Australia has had a rather tightly regu­ The first Australian case reports (Humulus lupulus L., Cannabaceae), oats lated market for herbs and other ''thera­ that implicated black cohosh with (Avena sativa L., Poaceae), and chaste­ peutic goods" since the passage of the hepatotoxicity were described in an berry (Vitex agnus-castus L., Verbenaceae). Therapeutic Goods Act of 1990. Of the Australian medical journaJ.2 The first and The reported presence of skullcap has 47 cases reported worldwide of alleged more serious case concerned a woman who raised some questions among botani­ hepatotoxicity associated with black was reportedly using an undefined black cally-savvy experts. In some formulations, cohosh-containing preparations, a number cohosh monoprepararion alone for one skullcap has been substituted with the of them have been reported in Australian week to treat menopausal symptoms. She herb germander (Teucrium chamaedrys L., medical journals.2,3 Thus, it is under­ presented with jaundice and subsequently Lamiaceae), a plant that has been previ­ standable that the TGA has taken an underwent a liver transplant. No specific ously reported as hepatotoxic3 and has interest and reviewed this iss ue. Based data is included in the report, e.g., the been known as an adulterant for skullcap, on its own criteria and processes, TGA brand name of rhe putatively offending at least in the herb trade in the United decided to iss ue this warning. In Austra­ product or a botanical or chemical analy­ States during the 1980s. lia, 4 patients were reportedly hospital­ sis. The authors of rhe report acknowl­ Whether or not germander substitution ized, including 2 patients who required edge that there were no previous reports has occurred in Australian herbal prod­ liver transplants. of hepatotoxicity associated with black ucts is nor clear, although an Australian The TGA acknowledged that "Although cohosh. regulatory expert contacted for this article some reports are confounded by multiple ex pressed doubts that this is likely since ingredients, by more than one medica­ there have been quality control measures tion or by other medical conditions, there instituted throughout the Australian herb is sufficient evidence of a causal associa­ industry since the passage of the Thera­ tion between black cohosh and serious peutic Goods Act in 1990. Specifically, hepatitis."! The TGA hastened to add the ge rmander issue had been raised in a note about the relative safety of black the Australian herb industry prior to these cohosh: " .. . considering the widespread case reports, and as a result many suppli­ use of black cohosh, the incidence of ers were surveyed by TGA on this issue. liver reaction appears to be very low." By 2002, many of the manufacturers were The TGA policy requires the following sensitive to the need to ensure the correct label statement on black cohosh products: identity of skullcap to preclude the possi­ "Warning: Black cohosh may harm the bility of rhe adulterant germander's pres­ liver in some individuals. Use under the ence. Australia has mandatory adverse supervision of a healthcare professional." I event reporting requirements for Listed The new policy goes into effect imme­ (e.g., herbs) and Registered (pharmaceu­ diately and will apply to all new products tical) medicines. Thus, TGA regulators with a 12 month phase-in period for exist­ might take the view that adverse event ing products. exposure data from other countries may Black cohosh Actaea racemosa Photo ©2006 It is nor clear what criteria or process be weakened by the lack of systematic stevenfoster.com was employed in the TGA's safety evalua­ adverse event reporting systems in those tion process; the publication of the warn­ countries. ing did not link to any other documents The second case concerned a 43-year­ With regard to the second case report2 related to this process. A TGA official old woman who had taken a prepara­ discussed above (and others), it appears involved with this new policy responded to tion containing black cohosh with several that no efforts were made to verify the several e-mails sent by this writer request­ other herbs for an undefined period of botanical identity of the herbal materi­ ing clarification on these points, writing rime.2 The formula reportedly contained als in the formulation. Further, the case that TGA would provide more data on the the following herbs : skullcap (Scutel­ report provided no information regard­ criteria and process at a future dare. [D. laria lateriflora L. , Lamiaceae), valerian ing the plant parts used in this prepara­ Briggs e-mail to M. Blumenthal, March (Valeriana officina/is L. , Valerianaceae), tion-a problem that is all too commonly 6, 2006.] However, despite several addi­ black cohosh, passion flower (Passiflora associated with many case reports alleging tional requests, ABC has not received any spp., Passifloraceae), dong quai (Angel­ toxicity associated with the ingestion of further communications from TGA. ica sinensis [Oliv.] Diels, Apiaceae), hops botanical preparations. Nor did it provide

60 I HerbaiGram 71 2006 www.herbalgram .org Legal & Regulatory

information regarding the characteristics given rega rding clinical trials on such black cohosh preparation, introduced into of the herbal preparation, e.g., the solvent, patients using black cohosh in which there the US market new packaging with the concentration, manufacturing process, or were negative findings; CSPI had been following wa rning, even though none of chemical analysis of the product taken. concerned about an incomplete study on the cases of hepatotoxicity reported to date Another Australian case of alleged black transgenic mice rhar had developed lung have been associated with this product: cohosh-associated liver toxicity involved rumors, bur the hi stology of the rumors "Consult yo ur hea lthcare practitioner a 52-year-old woman who was using a has nor been conducted ro determine if prior ro use if yo u have a hisrory of liver multi-ingredient herbal prepararion,4 bur they were malignant and rhe study has disease or are raking prescription drugs."8 due to the presence of numerous other never been published in a peer-reviewed Consistent with the conclusions botanical ingredients in the preparation, a journal.) of the N IH conference, the va rious direct causal association of any of the black Similarly, based on history of use, animal pharmacognosy, pharmacology, toxicol­ cohosh or any of the other individual ingre­ toxicology, and pharmacovigilance data ogy, and medical experrs consulted by the dients cannot be definitively determined. from Europe and elsewhere (5 1 case reports American Botanical Council to date do According ro this report, "The prepara­ from various international adverse event not believe that there are adequate scien­ tion was made and provided by a phar­ reporting databases were acknowledged), tific or medical data to support a direct macist. The preparation was supplied in the consensus of rhe experts assembled ar causal connection between black cohosh a 200 mL borde and contained a mixture the NIH conference concluded rhar there preparations and cases of hepatotoxicity. of the fluid extracts of Nepeta hederacea is inadequate evidence that black cohosh So far as ABC has been able to determine, (ground ivy) 80 mL [Editor's Note: This preparations are causally associated with a li ver-related warning for black cohosh is quoted directly from the publication hepatotoxicity. However, NIH concluded products is not required in any country in the MedicaL journaL of AustraLia; the that liver enzyme levels will be monitored other rhan Australia. HG preferred binomial for ground iv y probably in all women currently enrolled in NIH­ should be GLechoma hederacea.], Hydrastis funded trials on black cohosh, as a precau­ References canadensis (golden seal) 20 mL, Ginkgo tionary measure. I. Therapeutic Goods Adm inistration. Black biLoba (ginkgo) 40 mL, Avena sativa (oats The NIH workshop report states the co hosh ( Cimicifuga racemosa) . New label­ seed) 40 mL and Cimicifuga racemosa following: ing and consumer information for medi­ cin es co ntaining Black cohos h (Cimicifitga (black cohosh) 20 mL. According to the Ultimately, the workshop partic­ mcemosa). February 9, 2006. Available at information supplied by the pharmacist, ipants concluded that a balanced hnp:!/www.rga.gov.au/cm/blkcohosh.hrm. one gram of herb was contained in each approach be taken with respect to Accessed February I 0, 2006. 1 mL of extract, with the exception of this iss ue. On the one hand, millions 2. Whiting PW, C lousron A, Kerlin P. Black golden seal, for which 0.5 g of herb was of people have taken black cohosh cohosh and other herbal remedies associ­ contained in each millilirer."4 with very few adverse events reported. ated with acute hepatitis. Med J Austr. On the other hand, those cases of 2002; 177:432-435. NIH Acknowledges Safety of Black heparotoxicity associated with prod­ 3. Kouzi SA, McMurtry RJ, Nelson SO. Heparoroxiciry of germander ( Teucrium Cohosh ucts that are known to contain black chamaedrys L.) and one of irs constituent In an American case based on a 57-year­ cohosh and believed to be free from neoclerodane diterpenes teucrin A in the old woman who had been taking numer­ other substances of known toxicity mouse. Chem Res Toxicol. (United Stares) , ous prescription medications for 2 years, raise concern. Thus, the workshop November-December 1994;7(6) :850-856. the black cohosh was presumably a mono­ recommended rhar appropriate safety 4. Lontos S, Jones RM, Angus PW, Gow PJ. preparation taken for about 3 weeks. The parameters should be used in clini­ Acute live fa ilure associated with the use patient was nor certain about the contents cal studies of black cohosh. Such of herbal preparations containing black or the brand, as the package had already measures would include monitor­ cohosh. Med j Aust. 2003; 179:390-391. 5. Cohen SM, O 'Connor AM, Hart J, been discarded.5 The dosage used was ing liver function throughout the Merel N H , Te H S. Autoimmune hepatitis not reported. The publication of this case study period, specifically looking at associated with rhe use of black cohosh: A prompted the Center for Science in rhe alkaline phos phatase (A P), as par­ case study. Menopause (September-Octo­ Public Interest, a Washington D C-based tate aminotransferase (AST), alanine ber 2004); II (5) :575-577. consumer advocacy organization, to write aminotransferase (ALT), and bili­ 6. Cohen B, Schardt D. Letter from Center to the Food and Drug Administration rubin. And depending on what is for Science in the Public I merest to Mark suggesting label warnings, an FDA letter being studied, investigators should B. McClellan, FDA Commissioner, to physicians, and a consumer advisory.6 consider screening potential subj ects March 4, 2004. 7. Workshop on the Safery of Black Cohosh In response to these concerns, the for liver function to exclude individu­ in C linical Studies. Nati onal Center for National Institutes of Health (NIH) held a als with pre-existing liver problems. Complementary and Alternative Medi­ one-day "Workshop on the Safety of Black At rhis rime, there is no known mech­ cine and Office of Dietary Supplements, Cohosh in Clinical Studies" in November anism with biological plausibility that National Institutes of Health. November 2004.7 The conclusions were that there explains any heparoroxic activity of 22, 2004. Available at http://nccam.nih. was no competent evidence to support black cohosh.? gov I news/ pasrmeeri ngs/blackcohosh_ concerns about safety with respect to use In June 2005 Schaper & Brummer, the mrngsumm.pdf. of black cohosh in breast cancer patients. manufacturers of Remifemin", the world's 8. Remifemin" package text. (To the contrary, there was testimony most clinically-researched and rop-selling www.herbalgram .org 2006 HerbaiGram 71 I 61 Supreme Court Ruling Protects Religious Group's Access to Ayahuasca by Courtney Cavaliere and Mark Blumenthal he Supreme Court unanimously ruled on February 21, 2006, that a small religious sect may continue to import and utilize a hallucinogenic tea central to its ritual ceremonies.1 The court's decision rejected the federal government's efforts to T completely ban the tea as an illegal substance. The tea, known as ayahuasca or hoasca (the term preferred by the religious sect), is a decoction prepared from a combination of psychoactive plants native to the Amazon. The beverage is used in bi-monthly rituals of the religious sect, known as 0 Centro Espirita Beneficente Uniao Do Vegetal (UDV), as a way for participants to connect with the divine.2 The UDV originated in Brazil in the late 1950s, and its use ofhoasca tea as a ritual sacrament has been legally permitted there since the mid 1980s. The sect officially incorporated as a church in the state of New Mexico in the early 1990s.

The ruling has been hailed as one of the is chemically related to psilocybin, the most significant applications of the Reli­ active ingredient of "magic mushrooms" gious Freedom Restoration Act (RFRA) (e.g., Psilocybe cubensis [Earle] Sing, Srro­ of 1993. Under this act, the government phariaceae), and to the neurotransmit­ had to prove that there was a compelling ter serotonin. However, DMT is inactive reason for criminalizing the religious use if ingested orally, due to its enzymatic of ayahuasca tea by the UDV sect, that the degradation in the liver and gut by an tea posed actual harm to those who would enzyme, monoamine oxidase (MAO). It consume it, and that the ban was the least can be protected from peripheral degrada­ restrictive means for meeting government tion and enabled to cross the blood-brain interests.3 The Supreme Court, under the barrier in an active form by simultaneous leadership of recently appointed Chief ingestion of MAO inhibitors. A unique Justice John G . Roberts, Jr. , found that aspect of ayahuasca is that its pharma­ the government failed to provide such cological activity depends on this syner­ proof. gistic activity: beta-carboline alkaloids "I see this decision as being so impor­ in the "vine" B. caapi are potent MAO tant not only for the UDV but for what inhibitors and thus when prepared in it represents at this time in the country," combination with the DMT-containing said Jeffrey Bronfman, president of the leaves of one of the 2 admixture plants, United States chapter of UDV (e-mail to the result is an orally active preparation. M. Blumenthal, February 28, 2006). "At Under these circumstances, the effects of its core it is a profound affirmation of the DMT are slower to manifest and usually role plants have in support of our physi­ Ayahuasca Banisteriopsis caapi. Photo ©2006 last longer than when it is administered stevenfoster.com cal, mental, and spiritual well-being. The in some other manner (e.g., by injection, Supreme Court, as I see it, affirmed not active plants in mixtures that go by the as a snuff in the case of other plant-based only the fundamental principles of reli­ name ayahuasca. These additional plants preparations, or smoked). (For more on gious liberty that our country's democ­ include angel trumpet leaf (Brugmansia the chemistry and psychopharmacology racy was based upon, but also strongly spp. Pers., Solanaceae), known locally in of ayahuasca, see the recent review by reminded the government that there are Peru as toe, along with tobacco (Nicotiana McKenna 2004).5 clear limits to its authority in interfer­ tabacum L., Solanaceae) and others. Evidence suggests a long historical use ing with the most personal, central, and The term ayahuasca in the native of ayahuasca in various South American sacred dimensions of its citizens' lives." Quechua language means "vine of the cultures.4 According to the botanical text Ayahuasca is a shamanic plant potion soul"-a reference to the deeply mysti­ The Healing Forest, by the late Harvard derived from the jungle vine Banisteriop­ cal/spiritual experience induced by the ethnobotanist Richard Evans Schultes, sis caapi (Spruce ex Griseb) CV Morton, ritual use of the tea made from the bark of PhD, and chemist Robert F. Raffauf, Malpighiaceae, aka caapi and yaje or yage, the vine and the hallucinogen-containing PhD, the drink has been employed widely and other plants.4 Two plants typically admixture plants. in Amazonian Colombia, Ecuador, Peru, used in the Amazon as admixtures to The pharmacological activity of Bolivia, and Brazil, and to a limited extent ayahuasca are either Psychotria viridis Ruiz ayahuasca is derived from a synergistic along the uppermost tributaries of the & Pav, Rubiaceae or Diplopterys cabrerana interaction of active ingredients in the Rio Orinoco of Colombia and probably (Cuatr.) Gates, Malpighiaceae, depend­ ayahuasca mixture. Dimethyltryptamine adjacent Venezuela.6 In many of these ing on the geographical locale and plant (DMT) is a hallucinogenic alkaloid found cultures, ayahuasca is considered a medi­ availability.* The UDV's hoasca bever­ in the leaves of the admixture plants (P. cine, since many traditional healers or age consists of only B. caapi and P. viri­ viridis or D. cabrerana) . It is regulated shamans diagnose, cure, or treat illnesses dis. In addition to B. caapi and the plants under the US Controlled Substances Act and conditions while the healer and often just mentioned above, some shamans in as a Schedule I Substance.1 DMT is the patient are under its influence. They Amazonia utilize various other psycho- a potent, short-acting hallucinogen that believe ayahuasca gives them their healing

62 I HerbaiGram 71 2006 www.herbalgram.org l gal &Regulatory power through communion with the spirit "The Supreme Court Other factors that influenced the court's world. Or. Schultes and Dr. Raffauf's decision included a failure on the part photographic essay Vine of the SouL details affirmed not only the of the government to show a compel­ and illustrates the preparations and uses fundamental principles ling need for blocking the U DV's use of of B. caapi and other psychoactive plant­ ayahuasca tea on the basis of health ri sks.3 based preparations by Amazonian healers of religious liberty that The government further did not address and peoples.? Members of the Brazil-based how an exemption of ayahuasca fo r U DV's religious sect UDV, meanwhile, report­ our country's democracy religious purposes might adve rsely affect edly use hoasca during twice-monthly was based upon, but also the country's international relations (the rituals.2 Government had argued that the importa­ The 130 members of the U.S. sect of strongly reminded the tion of ayahuasca was allegedly prohibited the UDV sued the government under government that there are under the United N ations C onvention on the RFRA in 1999 after Drug Enforce­ Psychotropic Substances) .t ment Administration agents seized a ship­ clear limits to its authority T he government may still decide to ment of the tea stored at the UDV's New take its case to trial, as the recent Supreme Mexico offices and threatened the group in interfering with the Court decision was based only on a prel im­ with prosecution. T he case was presented most personal, central, and inary injunction. 2 However, according to to the Supreme Court after the govern­ an article in The New Yo rk Times, the ment appealed rulings in favor of the sacred dimensions of its court's rejection of the government's argu­ UDV made by both the US District C ourt citizens' lives," said ments was so conclusive that it seems for the District of New Mexico and the unlikely that a different decision would be lOth C ircuit C ourt of Appeals in D enver. Jeffrey Bronfman, reached through a trial. HG The Supreme Court justices sided against the administration's argument that president of the United R eferen ces ayahuasca should be banned to ensure States chapter of UDV. I. Gonzales v. 0 Centro Espirita Benefi­ the absolute authority of the Controlled cente Unio do Vegetal , No. 04- 1084. Substances Act.3 C hief Justice Roberts The USSC+ Database of U.S. Supreme Court Opinions Web si te. Ava il able at: claimed that the ad ministration could not consideration of a similar exception for the 130 or so American members of the UDV http:! /www.usscplus.com/currenr/cases/ dismiss the poss ibility of exceptions to such ASCII/9960030.txr. Accessed: Apr il 13, who want to practice theirs," C hief Justice laws, especially with regards to iss ues of 2006. religious freedom. Further, he pointed out Roberts wrote in the court's formal deci­ 2. Greenhouse L. Court in rra nsirion: that N ative Americans' permitted access sion.1 H e further wrote, "While there may Su preme Court ro un dup; sect al lowed to to peyote (Lophophora wiffiamsii [Salm­ be instances where a need for uniformity import irs hallucinogeni c rea. New Yo rk Dyck] J. Coulter, Cactaceae), a psychoac­ precludes the recognition of exceptions to Times. February 22, 2006:AI4. tive cactus used in traditional ceremonies, generally applicable laws under RFRA, 3. UDV wi ns Supreme Court decision on preliminary injunction allowing the use constitutes just such an exception to the it would be surprising to find that this was such a case, given the longstanding of th eir ayahuasca/hoasca rea. The Va ul rs federal controlled substances act. of Erowid Web sire. Availab le ar: http:// peyote exemption and the fact that the "If such use [of peyote] is permitted www.erowid .org/chemicals/ayahuasca/ in the face of the general congressional very reason Congress enacted RFRA was ayah uasca_law22.shrml. Accessed April 7, findings for hundreds of thousands of to respond to a decision denying a claimed 2006. Native Americans practicing their faith, right to sacramental use of a controlled 4. Whar is ayahuasca? Ayahuasca.co m Web those same findings alone cannot preclude substance." sire. Available ar: http://www.ayahuasca. co m/drupal/booklview/25. Accessed April I I, 2006. In Ecuador and the Putumayo regions of Colombia and Peru , rhe admixture used mosr 5. McKenn a OJ . Cli nical investigations of commonly is D. cabrerana; in rhe resr of rhe Am azo n basin, and around Iquiros and so uth of rhe therapeutic potential of Ayah uasca: there, P viridis is most often used. This is changing now as peopl e have brought D. cabrerana rati onale and regulatory chal lenges. ro rhe area from the north and a number of curanderos around Iquitos are starring to use it in Pharmacal Ther. 2004; I 02: I I 1- 129. preference ro P viridis. However, they are almost never mixed together in rhe same ayahuasca 6. Schulr es RE, Raffauf R. The Healing mixture. [D. McKen na e-mail toM. Blumenthal, April 17, 2006.] Forest. Porrland, OR: Dioscorides Press; 1990. t Whether hoasca/ayah uasca is prohibited under this Convention has bee n rhe matter of so me 7. Schul res RE, Raffauf R. Vine of the Soul. debate. T he District Court rejected rhe government's argument regarding international rela­ Santa Fe, NM: Synergetic Press; 1992. tions, claiming rhar hoasca is not covered under the Convention) Thar courr cited rh e official 8. Uni ted Nations Drug Control Program co mmentary to rhe Convention, which srares rhar plants are excluded from such regul ations Ayah uasca Poli cy Fax. The Vaults of because plants are distinct from rhe Schedule I substances derived fro m rhem. Li kewise, a Erowid Web si re. Availabl e ar: http:// 200 I fax from rhe Secretary of the Internati onal Narcotics Board , Herberr Schaepe, specifical ly www.erowid. org/chemicals/ayahuasca_ notes the exclusion of ayahuasca from the Convention's prohibirions.BT he Supreme Court, law I O.shrml. Accessed May 8, 2006. however, disagreed wirh rhe District Court and claimed rhar hoasca is subj ect to rh e Conven­ tion. 1 Despite rhis agreement with rhe government, rhe Court stated rh ar rhe government sri II did nor prove that there would be negative international ramifications by exempting UDV's sacramental use of hoasca. www.herbalgra m.org 2006 HerbaiGram 71 I 63 Market Report

Total Sales of Herbal Supplements in United States Show Steady Growth Sales in Mass Market Channel Show Continued D ecline by Mark Blumenthal, Grant K.L. Ferrier, and Courtney Cavaliere

otal sales for herbal d ietary supplements (HDS) have shown continued growth for most channels of trade, indicating a steady increase in both 2005 and 2004, compared to 2003. Unpublished sales statistics gathered from various primary and secondary T sources by Nutrition Business journal (NBJ) demonstrate a 3.4% increase from 2003 to 2004 and an additional 2.1 % increase in 2005 compared to 2004 fo r all HDS aggregated for all sales channels (see Table 1) .

D es pite the generally upward trend fo r the total level of sales for HDS in 2005 To understand the relative significance all aggregated sales, HDS co ntinued their reported by IRI ($249,425,500) would of the IRI data, as well as the aggregate ge nerally downwa rd trend in the main­ possibly be at least twice the reported sa les data compiled by NBJ, it is essen­ stream market (i.e., food, drug, and mass fi gure, si nce Wal-Mart alone has been ti al to recognize that HDS are sold in the market retailers, referred to as FDM) in termed the largest retail seller of dietary United States through a variety of market 2005, with total herb sa les in that chan­ supplements in the United States . channels. T hese include the following: nel being about 3.67% lower than sales fo r the sa me category in 2004, according Table 2. Sales of Top-Selling Herbal Dietary Supplements in the Food, Drug, to informatio n provided by Information and Mass Market Channel in the United States in 2005 Resources Inc. (IRI) of Chicago (see Table 2) . T he IRI data, considered by mos t Common Name Latin Name $ 2005 Sales (USD) % change 2004 knowledgeable observers as probably the 1. Garlic Allium sa tivum 26,244,200 -3.28 most re li able econometric sales data ava il­ 2. Echinacea Echinacea spp. 21 ,114,160 -11.21 able on herbal supplements for this particu­ lar channel does not include sales reports 3. Saw palmetto Serenoa repens 19,252,980 -5.42 fro m Wal-Mart, Sam's Club, and other 4. Ginkgo Ginkgo biloba 16,553,030 -14.54 large warehouse buying clubs, or sales 5. Cra nberry Vaccinium 15,839,160 16.97 fro m convenience stores. If such additional macrocarpon sales data we re available in the IRI reports, 6. Soy Glycine max 14,497,100 -17.12 Table 1. Total Estimated Herb Sales 7. Gin se ng* Pan ax ginseng 11,444,550 -6.19 in All Channels 1994-2005 8. Bl ack cohosh Actaea racemosat 9,736,738 -19.05 Year $Total Sales %Increase 9. St. John's wort Hypericum 9,035,399 -1.34 (millions) (-decrease) perforatum 1994 2,020 10 . Milk thistle Silybum marianum 8,312,867 6.77 1995 2,470 22.3 11 . Green tea Camellia sinensis 5,648,459 93.89 1996 2,990 21 .1 12. Evening primrose Oenothera biennis 5,303,904 -13.00 1997 3,557 19.0 13. Val erian Va leriano officina/is 3,435,420 -0.42 1998 4,002 12.5 14. Horny goat weed Epimedium spp. 2,184,910 -1.35 1999 4,110 2.7 15. Grape seed Vitis vinifera 2, 162,104 -7.14 2000 4,260 3.7 extract 2001 4,397 3.2 16. Bilberry Vaccinium myrtillus 2, 109, 174 -10.04 2002 4,276 -2.8 17. Red cl over Trifolium pro tense 1,7 18,605 -25.80 2003 4, 178 -2.3 18. Yo himbe Pausynys talia 1,542,5 13 -15.97 johimbe 2004 4,320 3.4 19. Horse chestnut Aescu/us 1,220,254 -14.95 2005 4,410 2.1 seed ext r. hippocastanum Source: Ferrier et al. Nutrition Business Journa/2006 (i n press).1 (www.nutritionbusiness.com) 20. Ginger Zingiber officina/is 862,719 5.75 NBJ (Nutrition Business Journan primary research includes NBJ surveys of supplement manufacturers, distributors, MLM Total All Herb Sa les [including herbs not $249,425,500 -3.67 firms, mail order, Internet and raw material & ingredient supply companies, as well as numerous interviews with major shown] retailers (Wai·Mart, Costco, etc.), manufacturers, suppliers and industry experts. Secondary sources include Information Source: Information Resources lnc.2 (http://us.infores.com/) Resources Inc., SPINS, ACNielsen, Natural Foods Merchandiser, * It is not clear from the IRI data whether this figure also includes the sales of American ginseng root products (made from Pa nax Whole Foods Magazine, Insight, The Hartman Group, company quinquefolius), the sa les of w hich are not as high as sales from supplements made from Asian ginseng (P. ginseng ). data and other published material. t The commonly used synonym and previously accepted binomial is Cimicifuga racemosa.

64 I HerbaiGram 71 2006 www.herbalgram.org Market Report

Table 3. Total Estimated Herbal of the most precise sales data have come the herb's strong antioxidant acnvny. from the FDM channel due to the fact (These statistics do not refl ect the increase Dietary Supplement Sales in US that the sales of herbs are reported by in green tea sa les as "teas," i.e., as bever­ Food, Drug, and Mass Market cash register and computer scanning data ages; this relates to HDS only. G reen (FDM) Channel- 1998-2005 to companies like IRI (http://us. infores. and white tea beverage sa les rose 18 % Year $Total decrease from com/) and AC N ielsen (http://www2. in 2005, fro m $ 136,041,305 in 2004 to Sales* previous year acnielsen.com). According to IRI data, $160,258,650 in US natural supermarkets 1998 731 ,651 ,520 as has been reported in H erba!Gram for and conventional food /drug/mass market the past 10 years, the 20 herbs that have stores [excl uding Wal-Marr], according to 1999 710,794,944 -3.0 enjoyed the top levels of sa les in the SPINS, a market research and consulting 2000 590,953,088 -15.1 United States in 2005 are shown in Table firm for the Natural Products Industry).3 2001 337,431 ,2oot -21.0 2 (the top 20 herbs sometimes varying With respect to the total marker es ti­ from one year to the next). It bears empha­ mated sales, the NBJ statistics indicate 2002 293,397,664 -13.9 sis that the total sales of herbal dietary that there has been an increase in herbal 2003 278,212,100 -5.0 supplements in the FDM channels consti­ combinations in 2004 and 2005. Table 2004 257,514,900 -7.4 tutes an estimated one-sixteenth of the 4 shows a 5.0% increase in combina­ totaL market for herbs in the United States, tion formulations in 2004 and another 2005 249,425,500 -3.7 according to aggregates of the total sales almost equal (4 .8%) rate of growth in *Data from Information Resou rces Inc. (IRI ) and published of HDS in the US market as compiled by 2005, after what appears to have been a in va rious Market Report articles in previous iss ues of Herba/Gram (i.e., issue numbers 49, 51 , 55, 58, and 66). NBJ. Readers are rhus cautioned not to precipitous decline of 18.6% from 2002

t iRI stopped reporting data from Wai-Mart stores, a signifi cant utilize the IRI sales statistics in Table 2 to 2003. The reduction is poss ibly due share of the sales in the FDM channel. without giving them proper context. to the fa lloff in sales of Metabolife• 356 As shown in Table 2, of the top-selling and a number of other ephedra-contain­ 12 herbal dietary supplements, 9 indi­ ing combinations during the period where hea lth and natural food stores; FDM cate lower sales in the FDM channel significa nt adverse publicity was gener­ as well other outlets in the mainstream in 2005 compared to the previous yea r. ated about ephedra (Ephedra sinica Stapf., market (e.g., warehouse buying clubs); This is consistent with the total of all Ephedraceae) in ge neral (a nd its banning convenience stores; mail order, radio herbs sold in 2005 in FDM, calculated at in HDS by the Food and Drug Admin­ and television direct sales, and Internet $249,425,5 00, or a 3.67% drop compared istration), and the Metabolife product in sales; companies that sell directly to the to 2004. During the past 7 or 8 years, particular. consumer (often called network marketing sales in the FDM channel have suffered Single herb HDS have not fa red as or multi-level marketing [MLM] compa­ a continual decline, punctuated by spikes well as combinations, according to the nies); health professionals in their offices in sa les for several herbs that have expe­ NBJ data. Singles (a ka monopreparations) (e.g., acupuncturists, chiropractors, natu­ rienced surges due to increased demand enj oyed a 3.2% growth rate in 2004 and a ropaths, some conventional physicians, et stemming fro m positive publici ty from slight decrease of 0.7% in 2005. a!.), and other smaller channels. clinical trials, market promotions, and/or Other channels of trade have experi­ Due to this wide variety of sales chan­ other social trends (see Table 3). enced a more stable growth pattern with nels and the lack of accurate econometric For example, Table 2 indicates that sa les in the health food /natural food store tracking services for these channels (as is sales for 3 herbs increased in 2005 (cran­ channel generally being the most consistent available from IRI in the FDM channel), berry, milk thistl e, green tea). T he most over the past decade (see Table 5). Direct, it is difficult to accurately measure the dramatic increase (94%) occurred with or non-retail, sa les have also performed precise level of sales ofHDS in the United green tea, the public perceptions of which better than the mainstream market but States. During the past 10-15 yea rs, some are influenced by growing publicity about have not been as consistent, although they did outperform natural channel sa les in 2005, mainly due to growth by MLMs. Table 4. Herb Sales by Category in All Channels: The better sales performance in natural Singles (Monopreparations) vs. Combinations and in direct sales channels is principally 2003 2004 2005 due to the fact that the so-called "core $Sales 0/o $Sales % $Sales % shopper," the consumer who has a rela­ (millions) Growth (millions) Growth (millions) Growth tively strong commitment to the philoso­ phy underlying the natural products and Total Single 2,810 6.0 2,900 3.2 2,880 -0.7 natural health li festyle-i.e., "natural is Herbs better"-are more willing to continue Total 1,400 -18.6 1,470 5.0 1,540 4.8 purchas ing and using herbal supplements Combina- despite negative media stories about lack tion Herbs of effective regulation, safety concerns, or results of negative clinical trials. On Total Herbs 4,210 -3.4 4,380 4.0 4,420 0.9 the other hand, much of the consumer So urce: Ferrier et al. Nutrition Business Journa/2006 {in press).l (www.nutritionbusiness.com) demand in the FDM channel comes from www. herba lgram .org 2006 HerbaiGram 71 I 65 Market Report

what marketing consultants refer to as ger dependence on the former availabil­ mangosteen (Garcinia mangostana L., "peripheral shoppers," consumers who are ity of ephedra-based weight-loss products, Clusiaceae), and goji/wolfberry (Lyceum more mainstream and less committed which have now been banned by the US spp., Solanaceae) juices. Many creative and to the natural health philosophy; these Food and Drug Administration, than the innovative companies are producing and consumers are more easily influenced natural or direct sales channels. marketing new ingredients and products by negative media reports and are thus Nevertheless, despite the appearance of that contain patented ingred ients and/or presumably less willing to continue to a downward trend in the FDM channel, those with clinical substantiation of safety purchase an herbal supplement in the face again chosen here due to the availability and efficacy. Despite downward price pres­ of growing negative publici ty. In addition, of better statistical data, the aggregated sures resulting from the importation of the mass market had a significantly stron- sales for all market channeLs as compiled by low-cost botanical ingredients and extracts NBJ strongly suggests from Asia, particularly China, the develop­ that the market for ment of proprietary patented and clinically­ Table 5. Herb Sales by Channel for 2005 herbs and plant­ tested ingredients and products promises to Channel $Sales % Increase based dietary supple­ help provide the American consumer with (millions) (-decrease) ments in the United an array of high-quality, safe, and clinically States appears to have effective herbal products. HG Ma ss Market* 713 -3 .5 stabilized 111 tradi­ Natural & Health Foodt 1,429 2.0 tional single-category References Direct Sales* 2,268 4.0 herbs, while offer­ I. Ferrier GKL, Thwaites LA, et al. US Consumer Herbal & Herbal Botanical Total 4,410 2.1 ing significant recent growth in condi­ Supplement Sales. Nutrition Business jour­ Source: Ferrier et al. Nutrition Business Journal 2006 (in press). 1 (www.nutritionbusiness.com) nal. 2006. In Press. tion-specific blends • Mass market includes food/grocery, drug, mass merchandise, club and convenience stores, 2. FDM Market Sales Data for Herbal including Wai-Mart, Costco, etc. (s till mostly weight­ t Natural & health food include su pplement and specia lty retail ou tl ets, including Whole Supplements, 52 weeks ending Janu­ Foods, GNC, sports nutrition stores, etc. loss) and certain new ary I, 2006. C hicago, IL: Information :f Direct Sa les include Mail Order (i ncluding catalogs), direct mail and direct response TV and categories like liquid Resources Inc. radio; practi tioners representing conventional and al ternative practitioners selling to thei r patients, including ethnic herbals and herb shops; Multilevel (M LM) or network marketing botanicals including 3. SPINSsca n Natural and SPINS- represen ting firms like Advocare, Herba life, Nature's Su nshine, Nu Sk in (Pharmanex), Nutrilite noni (Morinda citri­ scan Conventional, 52 Weeks Ending (Amway/Quixtar), Shaklee, etc. foLia L., Rubiaceae), 12/31105 vs . 52 Weeks Ending I I 1106.

66 I HerbaiGram 71 2006 www.herbalgra m.org Ingredients as unique as your fingerprint

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erbal Diplomats: The Contribution cal accounts of these early herbal diplo­ es ringly, many of the botanical remedies H of Early American Nurses (183 0- mats were not systematically recorded, as of rhar period were also aimed at cathar­ 1860) to Nineteenth-Century Health opposed to the healing practices of men. sis, bur were much ge ntler than the heroic Care Reform and the Botanical Medical Thus, a good dea l of the information practices of the Regulars. These remedies Movement by Martha M . Libster, PhD, comes from the "receipt book" journals were often combined with tonics and RN. Wes t Lafayette, IN: Golden Apple in which women recorded some of their botanicals with a more nourishing intent. Publi cations; 2004. 384 pages, hardcover. domes tic exchanges, such as foods and D r. Libster ex plores the archives of ISBN 0-9 755 01 8-0-1. $37.00. hea ling remedies. Many of these receipt 3 religious communities: The Shaker Author, nurse, and professor of nu rs­ books contai ned case study notes about Infirmary and Community N urses, ing history at Purdue University, Martha specific treatments. Additional sources the pioneer Nurses and M idwives of Libsrer focuses on the healing work and of information came from letters, diaries, the C hurch of Jesus Christ of Latter­ use of botanicals by women in rhe United and organiza tional reports. day Saints (Mormons), and the Sisters of States during the mid 19th T he author situates this kind Charity hospital nurses . She highlights century (1830-1 860). Dr. of activity within its historica l both commonalities and differences in Libsrer, who holds a doctor­ context. T he political climate how nurses in these distinct orga ni za­ are degree in Humanities and at this time was described as tions integrated healing practices from is an expert on the histor­ "Jacksonian democracy," one both the Regul ars and the Eclectics. Dr. ical and contemporary inte­ that va lued self care, nature, Libsrer describes their relati onship to the grati on of botanical therapies and an agrari an economy. Botanical Medical Movement (i n particu­ and nursing care, presents a The practitioners of what was lar T homsonianism), and the American most interes ting history about then considered conventional Indian healing practices related to botani­ herbal medicine during this medicine (labeled the "Regu­ ca ls. T he author includes many botanical time period. She also provides a lars") were moving toward a therapies, recipes, and remedies used for va luable addition to the history more scientific bas is, oriented va rious ailments. This book illuminates of nursing in the United States, around the control or domina­ how these nurses cas t a more feminine describing the roles of ea rly tion of nature. T hese practi­ approach to hea lth and healing. nurses who provided health services to tioners were generally unive rsity educated HerbaLDi plomats is well-researched and their communities. In recognition of its and constituted a relatively elite class. ex tensively documented with numerous excellence, this book was awa rded the This was the peri od of "heroic medicine," specific examples from each of the 3 2005 Lav inia L. Dock Award by the which refers to the use of treatments and exemplar groups. It makes an excellent American Association for the History of medications with a powerful action. Their contribution to women's history studies as Nursing. primary approach was to purify the body well as illuminating the contributions of T he women of this historical peri od using the techniques of bloodletting and women and nurses to healing and rhe use bridged rhe gap between domes ti c and administering powerful emetics (which of botanicals. T his book contains interes t­ public domains by bringing to their produced vomiting) and cathartics (which ing and releva nt material for those inter­ communities the knowledge of health acted as powerful laxatives). es ted in the history of herbal medicine in and healing through botanical remedies. This was also a time of medical plural­ the United States. It also makes a much T he author describes in-depth case stud­ ism and several different groups of health needed contribution to the history of the ies from 3 orga nized groups of nurses : providers were practi cing. Dr. Libster nursing profession by documenting this Shakers, Latter D ay Sa ints, and Sisters describes the work of "Empirics," later work of ea rly nurses, prior to standard­ of Charity. T hese groups are representa­ called the "Eclectics," who embraced more ized education and professionalization. tive of the early organiza tions of nurses in natural cures and the use of botanicals. T he author provides numerous references the United States . During the mid 19th M ost of Empirics did not have a univer­ and admirable scholarship, which makes century, there were few hospitals, and the sity education. H owever, they were often it an excellent reference book. It is recom­ role of nurses was that of a community very knowledgeable about botanicals or mended for both academics and the liter­ resource or healer. T he author situates the herbal medicine. One of the mos t promi­ are lay audience. HG nurse's role in the cultural context of ea rly nent groups of hea lth providers were the -Joan C. Engebretson, DrPH, 19th century when women's work was Thomsonians, who developed a "Materia AHN-BC, Professor, University of Texas largely relegated to the domestic sphere, Medica" based on botanical remedies from Health Science Center at Houston, in contrast to men's work in the public American Indian, immigrant, folk, and School of Nursing spheres. Women's work had tradition­ domestic remedies. Many of these reme­ ally incorporated the hea lth care of their dies were patented and became known as oisonous Plants: A Handbook for fam il ies and members of their communi­ "patent medicine." As Ameri ca became PDoctors, Pharmacists, Toxicolo­ ti es . Using detailed examples from these more urbanized and industri ali zed, profes­ gists, Biologists, and Veterinarians, 2nd 3 groups, D r. Libster asserts that these sional biomedicine emerged as the domi­ Edition, by Dietrich Frohne and H ans women acted as herbal diplomats by bring­ nant practice, incorporating many of the Jurgen Pfander, lnge Alford (Translator). ing rhe domes tic knowledge of botani­ botanical remedies into pharmaceuticals. Portland, OR: T imber Press; 2005. H ard­ cals to the public. In keeping with their Many of these early nurses worked with cover, 469 Pages. ISBN 0-88192-750-3. more domes tic roles, the written histori- both the Regulars and the Empirics. Inter- $150.00.

68 I HerbaiGram 71 2006 www.herbalgram.org Book Reviews

Poiso nings continue to occur in human many plants used commonly as food, European classic has been substantially beings and animals throughout the world, ornament, or medicine can indeed be revised and updated, containing approxi­ both from intentional and accidental roxie if consumed at the wrong stage of mately 60% more information than the encounters with a variety of plants. Small growth or by employing the wrong part previous edition. New information is children are usually the mos t affected of rhe plant, which could be both ined­ included about plant poisonings, as well as population, since their natural inquisitive­ ible as well as roxie. Species that can cause a broader coverage of plant species outside ness entices them to handle and some­ allergies or dermatitis by contact are also the main geographic scope of this text, times taste diverse plant parts such as included. which had been central Europe. flowers, fruits, or leaves. There is also a discus­ Information about North American Adult poisoning is also not sion about how plant poisonous plants has been included as uncommon, due to the misin­ poisonings usually occur, an ap pendix thanks to the collaboration formation and misidentifica­ as well as the most of Kark C umprsron, PhD, and rhe !are tion of wild plant gatherers common species usuall y Patrick Mckinney, PhD, borh from rhe and others who seek danger­ involved. University of New Mexico. Within this ous "recreational" experi­ The diverse roxie appendix, the description of toxicity for ences with some plants such constituents contained in many American species used in herbal as "Jimsonweed" or "Thorn plants, such as alkaloids, medicine is expounded, as is the case of apple" (Datura spp.). Such glycosides, roxie amino blue cohosh ( Caulophyllum thalictroides si tuations may end in tragedy acids, terpenes, and [L.] Michx., Berberidaceae), for example, because many people do not the like are also briefly which can cause serious toxicity during have a reliable and well-illus­ mentioned. T his cata- pregnancy if used irresponsibly. trated source of information logue of plants poison­ The authors nor only mention the roxie regarding the toxicity of various members ous to humans and animals is arranged properties and botanical characteristi cs of of the plant kingdom. in alphabetical order by botanical fami ly, rhe plants as mere academic information, Livestock and pets may also be poisoned including the most important representa­ bur provide an insert with rhe treatment by eating feed contaminated with roxie tives of toxicological interest contained in {if known) regarding each species. This plant parts, or simply by grazing poison­ each family. fea ture makes the book even more prac­ ous plants when other more palatable or This second English edition of this tical for those involved in poison control nutritious plants are unavailable. Professor Dietrich Frohne and Dr. H ans ]. Pfander are both researchers at the University of Kiel, Germany, who have continued to update this important compi­ lation of information about hundreds of plants contained within approximately 89 botanical families, which are potentially Best Botanical Book of 2005 toxic to humans, livestock, and compan­ ion animals. he Essential Guide to Herbal Safety by Simon Every economically important botani­ T Mills and Kerry Bone. 2005. Presents an extensive cal family that contains roxie species is discussion of principles of and current major issues mentioned, including a description of its in herbal medicine safety. Contains comprehensive most salient morphological characteristics. reviews of the published safety data for 125 herbs. For every plant discussed herein, the roxie Covers issues of quality, interactions, adverse reactions, toxicity, allergy, constituents are thoroughly covered, as contact sensitivity and idiosyncratic reactions. Hardcover, 704 pp. B535. well as the methods of treatment. In some $64.95 ABC Member Price 10% off: $58.46 cases, beautiful color pictures of the plant, as well as black and white line drawings • Provides the most current information on safety issues in herbal of its offending chemical compounds, are medicine. also provided. A selected bibliography for • Presents authoritative and credible safety information from two further reading is found after the descrip­ experienced herbal practitioners. tion of each plant family. The first English edition of this text • Combines theoretical chapters with 125 well-researched monographs, appeared in 1984 and quickly became making it the most thorough and comprehensive text on the market for popular with the scientific community herbal safety in practice. worldwide due to its ample coverage of plants that are potentially or actually roxie To order, calll-800-373-7107 to both humans and animals. or email to [email protected] The authors begin by defining a poison­ ous plant. This is indeed necessary, as or order online at www.herbalgram.org

www.herbalgram.org 2006 HerbaiGram 71 I 69 Book Reviews

centers and hospitals who need a quick certain plants, instead of the misguided nists, agronomists, and others interested reference guide that not only includes the "eradication" approach so common in in a serious and in-depth coverage of color picture of the plant for identifica­ many misinformed publications. toxic plants, not only from Europe, but tion purposes, but which also suggests the We must learn to identify and avoid throughout the world. HG currently accepted mode of treatment or the most common offending species, -Armando Gonzilez Stuart, PhD support for the intoxicated patient. with the understanding that even the University of Texas at El Paso, Doctors Frohne and Pfander have most toxic plant, when used correctly, may UT Austin Cooperative Pharmacy included a useful synopsis of berry-like have an important medicinal or therapeu­ Program fruits in table format which aids toxicolo­ tic value for both humans and animals. gists and others in the correct identifica­ The Western yew tree (Taxus baccata L., andbook of Analytical Methods tion of the plant, according to the type, Taxaceae) has been known to be poison­ Hfor Dietary Supplements by Frank color, consistency of the fruit, and growth ous for many centuries, yet the anticancer Jaksch, Mingfu Wang, and Mark Roman. habit (woody, herbaceous, epiphytic, etc.) compound paclitaxel (commonly known Washington, DC: American Pharmacists of the plant involved. as Taxol") has been derived and eventually Association; 2005. Hardcover, 215 pages. The book also contains a section with synthesized from this species and is now ISBN 1-58212-055-2. $197.95. black and white pictures of leaves that employed to treat breast cancer. This book is basically a compilation of point out the characteristic leaf features, Podophyllotoxin and vincristine are 2 HPLC (high-performance liquid chro­ which can be an invaluable source for the other anticancer compounds which have matography) methods for the analysis of correct identification of the plant involved been obtained from the may apple (Podo­ predominantly "popular" herbs and some in an intoxication. Since time is of the phyllum peltatum L. Berberidaceae) and of the more common dietary supplements essence in any intoxication, this infor­ the lesser periwinkle ( Catharanthus roseus), used in this industry today. There are mation will be very handy when making respectively. 38 monographs in all, each with a stan­ split-second decisions regarding the treat­ Some potentially poisonous plants may dard format for quick reference. Entries ment for a particular species of plant be present in homes, gardens, and perhaps include chemical names, formulas, and involved. even children's school yards. These plants structures, along with information on A glossary of botanical terms has been usually occur as hedges or decorative solubility and other physical/chemical added and is a useful tool for understand­ houseplants, while others may be consid­ data. Also provided are a brief description ing the botanical terms used throughout ered simply as weeds. For this reason it is of common uses and the mode of action, the book. important to know which plants could, if known. An important aspect of this work is that at some point, pose a hazard to people or With new final rules for current Good the authors caution readers not to look at pets. Manufacturing Practices (GMPs) soon plants with fear and suspicion, but rather This long-awaited new edition will to be published by the Food and Drug encourage them to learn, as well as teach certainly be a valuable addition to the Administration, this book is a timely their children, about the risks of handling libraries of physicians, veterinarians, bota- publication that will help fill the analyti-

New Book Profiles Sacred Mushroom of Visions: Aromatherapy Science: A Guide for FL: CRC Press, Taylor & Francis Group; Teonandcatl. Ralph Metzner and Diane Healthcare Professionals. Maria Lis­ 2006. 507 pages, hardcover, 172 chemi­ Conn Darling, eds. Rochester, VT: Park Balchin. London: Pharmaceutical Press; cal structures, 102 figures, 73 schemes, Street Press; 2006. 293 pages, softcover, 2006. 462 pages, hardcover, contents, and 64 tables, references. $79.95. ISBN contents, b&w photos, figures, refer­ bibliography, appendices, index. $69.95. 0-8493-1572-7. ences. $16.95. ISBN 1-59477-044-1. ISBN 0-85369-578-4. Defines more than 470 nutraceuticals Surveys the history of mushrooms Provides healthcare professionals with and phytocompounds and provides that contain the psychoactive substances science-based information pertaining to the latest facts and research for each psilocybin and/or psilocin. Offers an aromatherapy. Provides detailed, scien­ entry. Gives the biological and chemical assortment of information on ancient tific monographs on the essential oils activities that constitute the health and Aztec traditions, twentieth-century and absolutes available in the United disease-modifying properties for each scientific studies and psychotherapy, as States and Europe. Introduces basic herb, plant, vitamin, or compound. Each well as many detailed personal accounts concepts of aromatherapy along with entry is followed by authoritative refer­ of mushroom ingestion by individuals historical, chemical, and biological back­ ences. desiring enhancement of their spirituality ground information. Covers safety issues Medicinal Spices: A Handbook of and consciousness. Additionally explains and clinical trials. Culinary Herbs, Spices, Spice Mixtures the global distribution, biochemistry, Dictionary of Nutraceuticals and and Their Essential Oils. Eberhard and neuropharmacology of these types Functional Foods. N.A. Michael Eskin, Teuschner. Edited and translated by Josef of mushrooms. PhD, and Snair Tamir, PhD. Boca Raton, Brinckmann and Michael Lindenmaier.

70 I HerbaiGram 71 2006 www.herbalgram.org Book Reviews

ca l gap for the dietary supplement (OS) search through university or we b-based much about a method rhar is n't neces­ industry. Regulatory considerations libraries for any references to a particular sa rily revealed fro m the data alone. Data combined with increased competitive method of analysis. In the lab, we usually are great but chromatograms are what pressures have created a growing need for have to combine va ri ous methods from we frequently use to eva luate a method. accurate analytical res ults from laboratory different research papers as part of the If there were more chromatograms, this testing of botanical raw materi als, their method development process. book wo uld be even more va luable to extracts, and finished products. With Finally, we can now look at one source the natural products chemist. Second, so many di fferent methods of analys is and find analytica l methods for many although there is generally enough in fo r­ becoming ava il able for the common as wel l as uncom­ mation to ca rry our the analys is, some same botanical ingredient, mon herbs and dietary of the methods leave out derails in the it has become necessary for Handbook of supplements. In almost every method preparation that could be impor­ Analytical Methods members of the herb indus­ monograph, this book pres­ tant. Fortunately, the reference to the ori g­ for Dietary try to use not only valid but Suppl~ ents several methods. This inal publicati on of the method should be "validated" methods of anal­ - 3 is a particularly nice fe ature useful in these situations. T hese sugges­ ys is to ensure the "identity, because one has the oppor­ tions would provide a welcome add ition purity, quality, strength, and tunity to review, compare, to a well written and researched book of composition of their dietary and contras t several valid analyti cal methods fo r OS. H ingredients." Accordingly, methods. M any of the All in all , we give this book "two this book provides natural methods offered are from thumbs up." It accomplishes irs purpose products chemists with the peer reviewed journals and of providing a sa mpling of analytica l necessary confidence in their include a reference to the methods, along with appropriate va li da­ quantitative analys is for some original publication. Some tion data when available, fo r some of the of the marker compounds of the methods presented more common herbs and OS in commerce contained within these include an additional section today. Now all the authors have to do is complex systems. describing different levels of validation continue publishing these practical lab Anyone involved with the analysis of data. books fo r all the natu ra l product compa­ OS will want to have this book in his or Some minor improve ments would nies and their analyti ca l chem ists, and her library. Moreover, it is probably an make this book more complete. First, thus make their lives a little easier. HG indispensable resource for any analytica l it wo uld be helpful to have more actual -Sidney Sudberg and chemist involved in botanical OS analys is. chromatograms fo r any and all meth­ Jennifer Terrazas The book has much to offer an industry ods as well as the spectra of the va ri­ Alkemists Pharmaceuticals, Inc. sorely lacking this kind of reference mate­ ous compounds of interest. A picture is ri al. Too frequently, compendia! methods worth a thousand words-especially when are not available, and one typica lly has to it comes to chromatography. It reveals

Boca Raton, FL: CRC Press, Taylor & Germany: Georg Thieme Verlag; 2004. Textbook of Natural Medicine. Third Francis Group; 2006. 459 pages, hard­ 503 pages, softcover, contents, 5 tables, Edition. Joseph E. Pizzorno, Jr., and cover, contents, list of abbreviations, 173 11 b&w illustrations, appendix with Michael T. Murray, eds. St. Louis, MO: full-color illustrations, 36 b&w illustra­ Latin-English plant glossary, dosages, Elsevier Ltd.; 2006. 2368 pages, hard­ tions, 498 chemical structures, index of addresses, references, and index. $34.95. cover, contents, b&w figures, charts, general references, subject index, photo ISBN 1-58890-063-0 (US), ISBN 3-13- tables, appendices, index. $229.00. ISBN credits. $149.95. ISBN 0-8493-1962-5. 126991-X (Germany). 0-443-07300-7. Describes 300 plants and the spices Provides plant summaries that This revised version of the classic that are obtained from them. Provides cover pharmacology, indications, two-volume edition offers extensively comprehensive monographs on 84 culi­ contraindications, dosage information, researched and referenced information nary herbs and spices. Extensive infor­ adverse effects, herb-drug interactions, on the practice of natural medicine. Six mation on chemical constituents, phar­ and references for more than 100 herbs. separate sections provide evidence-based macological actions, sensory properties, Includes specific herbal treatments and overviews into the various topics regard­ potential toxicity, as well as culinary and procedures for diseases involving every ing complementary and alternative medicinal uses. Covers the production human organ system, from cardiovascu­ medicine, such as its history, diagnostic of spices from breeding and cultivation lar to urogenital, with a separate section procedures, and varieties, as well as phar­ to quality standards and governmental for pediatric diseases. Offers disease­ macology and disease-specific issues and regulations. specific clinical considerations and treatment approaches. Provides compre­ Pocket Guide to Herbal Medi­ explains the basic fundamentals and hensive summaries on more than 70 cine. Karin Kraft, MD, and Christo­ guidelines of phytotherapy. natural medicines and over 70 specific pher Hobbs, LAc, AHG. Stuttgart, health problems. HG

www.herbalgram.org 2006 HerbaiGram 71 I 71 In Memoriam

"By age five, three tribal nanus, encouraged Native Americans to improve respected elder women whom she called their quality of lives through traditional her 'grandmothers,' had singled her out to Indian craft skills.4 receive the store of traditional practices, "The strategy would also make the beliefs, and lore that comprise Mohegan native economy a vehicle for handing culture," wrote Peter Nichols in the arti­ down traditional tribal skills," said Nich­ cle, "Running Against Time."4 ols. "She taught Indian art and handiwork Her nanus, Lydia Fielding, Mercy Ann on several Lakota reservations, invited Nonesuch Mathews, and Emma Baker, accomplished Native American artists to guided Tantaquidgeon in her youth as she come and teach, and exhibited the art in learned the ways of tribal spirituality and museums across the country." herbalism. 1 Ultimately, she had the honor In the 1940s Tantaquidgeon worked as Gladys lola of becoming only the third medicine a librarian at the Nianric Women's Prison Tantaquidgeon woman of her tribe since 1959.2 in Connecticut.1 In 1947 she returned In 1919, she enrolled at the Univer­ home to Mohegan Hill to work in the 1899-2005 sity of Pennsylvania to study anthropol­ museum. She gave public tours until she ogy alongside Frank Speck, the founder was 99.6 ladys lola Tantaquidgeon, aka Mohegan Medicine Woman, of the college's anthropology department Tantaquidgeon received numerous and longtime Mohegan field researcher awards for her lifetime of good works, passed away November 1, 2005, G and friend.4 It was there her great niece, including the National Organization for at the age of 106. She died peacefully of Melissa Fawcett, said Tantaquidgeon was Women's Harriet Tubman award, the natural causes at her home on Mohegan exposed to new ways of thinking, to other Institute for American Studies' Hall of Hill in Uncasville, Connecticut. At the time of her death, she was the oldest living Indian tribes, and to courses which broad­ Elders award, and induction into the ened her academic focus.4 Her research at Connecticut Women's Hall of Fame. I She member of the Mohegan Indian Tribe. I Among her many achievements, Tanta­ the University eventually led her to write never married nor had children, but her quidgeon played a critical role in disprov­ her best known book, A Study of Dela­ legacy conrinues in the hearts of all whom ware Indian Medicine Practice and Folk she taught or inspired. ing the "Last of the Mohicans" myth Belief (Commonwealth of Pennsylvania, "She was Mrs. Mohegan. I always looked which, repopularized by the 1992 movie Dept. of Public Instruction, Pennsylva­ at her as such," Lifetime Mohegan Chief of the same name, was based on James Fenimore Cooper's 1826 French and nia Historical Commission), published in Ralph Sturges told the Norwich Bulletin. Indian War noveJ.2 The novel ended with 1942 and reprinted in 1972 and 2000 as "And I know that a lor of people will miss the Mohegan's Chief Uncas' dying, leav­ Folk Medicine of the Delaware and Related her. When you miss a shining light, you ing no heirs, and signifying the end of Algonkian Indians (Pennsylvania Histori­ don't realize it until it goes our."6 HG cal Museum Commission).5 the tribe.3 & -Cynthia Crimmins Tantaquidgeon, however, knew better Though she never graduated from college, Tantaquidgeon received honorary Tantaquidgeon knows how to make cough of this myth. She was a lOth generation descendant of Chief Uncas who, contrary doctorates from Yale and the University of remedies from the inner bark on the south to Cooper's account, lived a long life Connecticut in recognition of her achieve­ side ofmaple trees and that a howling dog is ments.4 and had many children.2 Tantaquidgeon a herald of death. She knows that the rela­ worked tirelessly to document the tribe's In 1931, Tantaquidgeon, her father, tionship ofher people, the Wolf People, with and her brother opened the Tanraquid­ birds and animals, lands and waters, rocks continuing existence through in-depth geon Indian Museum, now considered the record-keeping and artifact preservation. and plants is profoundly different from the oldest Native American-run museum in In 1994, Tantaquidgeon's efforts were experience of most in Western society. She the United States.5 Displays are not exclu­ paramount in the United States Bureau of knows that we inhabit a vast and living sive to the Mohegan tribe and include arti­ Indian Affairs' decision to officially recog­ cosmos in which aLL things are related and nize the Mohegan tribe, now with 1700 facts from a variety of Native American that it is "good medicine" to give thanks for members.4 Tantaquidgeon also success­ tribes. Tantaquidgeon enjoyed educating aLL the blessings. Above aLL, she remembers fully campaigned against the use of the others about Indian culture and sharing the ancient legends and knows that time Dutch word "Mohican" in favor of the the oral tradition of sroryrelling.4 She was moves swiftly, despite the fact that Earth is often heard saying, "You can't hate some­ English word Mohegan, which in their mounted on the back of Doyup, Grandfa­ one that you know a lot about.''3 native language means "wolf."2 ther Turtle. Born in 1899, the third of seven chil­ By 1934, Tanraquidgeon decided ro -Peter Nichols, editor, Penn Arts & take a job with the Bureau of Indian Sciences Magazine; author, Tantaquidgeon dren to John and Harriet Fielding Tanta­ quidgeon, both Mohegan Indians, Tanta­ Affairs and went to work helping the Indi­ biographical article, "Running against quidgeon's childhood was steeped in ans on the Yangron Sioux Reservation in Time." Mohegan tradition and culture.! Most South Dakota.5 In 1938, motivated by the poor living conditions on the reservation, References of the males in her family served as tribal I . Gladys Tanraquidgeon, Mohegan tribe's chiefs, including her brother Harold, and she rook a position with the newly formed matriarch and spiritual leader passes away at the women as tribal marriarchs.2 Federal Indian Arts and Crafts Board and

72 I HerbaiGram 71 2006 www.herbalgram.org In Memoriam

rhe age of I 06. The Mohegan Way Newsletter. he could predict at what bend or mile References Fa ll 2005; l-2. marker a particular flower would appear. I. Marrin D. Ed Peterso n, I 00, Seedsman 2. Oliver M.G. Tanraquidgeon, 106, Tribal His "search and re-search " technique was Who Collected California Wildflow­ elder helped prese rve Mohegan traditions. to find a plant in bloom and then come ers. The New York Times. November 27, Los Angeles Times. November 2, 2005: 88. 2005;0biruaries:33. 3. Reed C. Gladys Tanraquidgeon: Fighting back when ir had turned brown and gone 2. Theodore Payne Foundation Web sire. for rh e rights of rh e Mohegans. Guardian. to seed. He call ed it "re-search" because ir Press Releases. Avai lable ar: hrrp: / /www. November 15, 2005: Obituaries. was often as difficult to find the plant rhe rh eodorepayne. org/ newsroom/ press_ 4. Nichols P. Running aga inst rim e. Penn second time as it was rhe first. I Seed hunt­ releases.hrm. Accessed March 23, 2006. Arts and Sciences Magazine. Summer 200 I . ing, Peterson happily pointed our, was 3. Theodore Payne Fou nd at ion Web sire. Avai lab le at: hnp:/ /www.sas. upenn.edu/ better rhan fishing, because "we always Winrer 2005 Newsletter. Availab le sasalum/ news lrr/ summer200 1I running. come back with somerhing."4 ar: hnp://www. th eodorepayne.org/ html. Accessed Apri l 11 , 2006. In recent years, he continued his hikes pop pyprinr/05-4.pdf. Accessed March 23, 5. Gladys Tanraquidgeon, I 06, Mohegan's 2006. Medicine Woman. New York Times. Novem­ despite becoming legally blind 5 yea rs 4. Arroyo Seco Foundation Web sire. News ber 2, 2005:Cl8. ago. He knew hundreds of flowers and of rhe Arroyo 2005, LA Times Obitu­ 6. Durkin J. Mohegan-The Mohegan tribe identified them by others' descriptions, ary. Avai lable ar: http://www.arroyoseco. has lost its matriarch and longtime culrural giving both common and Larin names . org/ news200 5.php 'arric= 506. Accessed leader. Norwich Bulletin. November 2, 2005 H e regarded rents as a "nuisa nce" and March 23 , 2006. Obiruaries. slept on the ground, including on his last outing to Anza-Borrego D esert Srare Park on his 100'h birthday in rhe spring of 2005. I Edward Leslie Peterson was born in Los Angeles on April 8, 1905, and grew up in Hollywood, where he watered his family's Shasta daisies and tended the vegetable garden. After high school, he worked at a local nursery for 3 years before attending rhe University of Cali­ fornia, Los Angeles to earn a degree in botany in 1930.4 He spent rhe nex t 25 Edward Peterson yea rs as landscape supervisor at Los Ange­ les City College. Jeannine Parvati Baker 1905- 2005 "He was a superb amateur botanist and 1949-2005 an expert on rhe propagation of native d Peterson, who collected wild­ plants from seeds," said Bob Cates, histo­ elebrated author and midwife Jean­ flower seeds across rhe deserts, ri an of rhe Angeles chapter of rhe Sierra nine Parva ri Baker passed away on mountai ns, and meadows of South­ E C lub, which Mr. Peterson joined in 1938.4 December 1, 2005, in Joseph, UT. ern California, died on November 14, C In rhe !are 1940s, Peterson won a contest She was 56 years old. 2005, at a nursing home in Los Ange­ to name rhe newly launched newsletter of Ms. Parvati Baker had long served as les.! He was 100 and the oldest surviving rhe C lub, earning a lifetime subscription. a reacher and advocate of natural child­ member of the Angeles Chapter of the The microscopic seeds Mr. Peterson birth and therapies. She wrote hundreds Sierra C lub.2 found were sold by the apothecary spoon­ of articles on health and wellness, as After helping launch the Theodore ful , nor by rhe pound, he told the Los well as several books. Ms. Parvari Baker Payne Foundation for Wildflowers and Angeles Times in 1988. "You could start further promoted gentle birth practices, Native Plants with a mission to preserve as an infant and die a centenarian, and non-circumcision, and natural therapies the area's native flora, he began rhe seed you couldn't gather 20 pounds of Califor­ through her many presentations at confer­ collecting program in 1962.3 In addition nia fuchsia seed in your lifetime," he said ences throughout the world. to collecting seeds, he sorted, cleaned, wisrfully.1 "She was one of rhe first herbalist reach­ packaged, and sold them. According to the Collecting seeds, nature's most basic ers ar rhose early herb conferences back in Foundation, he served "with exceptional creation, helped "give purpose to my li fe, " rhe ea rly seventies, and her teachings li ve distinction for 45 years" and "amassed a he said in a 1998 interview. "Ir has kept on through rhe thousa nds of people who knowledge of native plant seeds that is me going through these years."4 studied wirh her," sa id Rosemary Gladsrar, unsurpassed ." 2 Rather rhan having a traditional service, founder of United Plant Savers, author of Despite vicious thorns and occasional his fa mily elected to spread his ashes on several books on herbs, and long-rime rattlesnakes, Mr. Peterson persisted, often Mr. San Jacinto rhe following spring at a friend of Ms. Parvati Baker (e -mai l, April on his hands and knees, in floral expedi­ spot where he and his brothers camped as 10, 2006). "She had a huge influence tions rhar annually yielded no more than children and first learned to appreciate rhe on women, conscious conception, and 20 pounds of mostly minuscule seeds. wilderness.2 HG rhe home birth movement. That was her He knew the backcountry so well rhar -Nancy Dennis specia lry." www.herbalgram .org 2006 HerbaiGram 71 I 73 In Memoriam

Ms. Parvati Baker was born in Los influence. "Whenever, wherever Jean­ Miriam Steinitz-Kannan, PhD, profes­ Angeles, CA, on June 1, 1949. The story nine spoke, her word magic transformed sor of biology at NKU and close associ­ of her own hospital birth, described by her the people listening to her," Gladstar ate of Dr. Thieret for 26 years, said Dr. parents as traumatic, inspired her initial explained. "She wrote and spoke in poetry, Thieret attracted many students to the interest in birth psychology, as well as her but it wasn't always easy to listen. She was study of botany, some of whom had very life-long advocacy of natural and gentle fierce and tough at times, like the desert little previous knowledge of plants (Stein­ childbirth practices. She began studying she lived in. And she fought relentlessly itz-Kannan M , oral communication, June such topics at San Francisco State Univer­ for those things she believed in, with her 1, 2006): "He got so many students inter­ sity, ultimately earning both her bachelor's words and her writings. I say, thank the ested in botany-that's probably his great­ of arts and master's degrees in psychol­ goddess, for the world has changed a little est legacy! He adored botany and had a ogy at that institution. Her personal birth for the better because of her." tremendous eye for diversity. He had such history, as well as her experiences study­ Jeannine Parvati Baker is survived by a passion for the field that it was conta­ ing with the famous Indian guru Baba her mother, sister, 6 children, and 1 grand­ gious. We're going to miss that a lot." Hari Dass, motivated her to write Prena­ child. HG For many years, Dr. Thieret also actively tal Yoga and Natural Childbirth in 1974, -Courtney Cavaliere worked in an advisory or editorial capac­ which was the first book on prenatal yoga ity for various organizations and publica­ in the West. She published her second Source tions) He was an editor of the journal book, Hygieia: A Womans Herbal, in 1979, Jeannine Parvati Baker. Birthkeeper Web site. Economic Botany for over 25 years, from which se rved as her master's thesis. Ms. Available at: http:/ /www.birthkeeper.com/ 1959-1984, and later also served as the Parvati Baker later co-authored a third Obituary.html. Accessed: January 24, 2006. journal's associate editor. He was an advi­ book, Conscious Conception: Elemental sor in botany for the Encyclopedia Britan­ journey through the Labyrinth of Sexuality, nica, a member of the Board of Trustees with Frederick Baker and Tamara Slayton for the Lloyd Library in Cincinnati, and a in 1986. member of the editorial committee of the Ms. Parvati Baker actively worked as Flora of North America Association, to a midwife and yoga instructor for many name just a few. years, then taught such skills through Another lauded accomplishment was both an informal correspondence course his founding and development of the on midwifery and an apprenticeship NKU herbarium.2 His research and field program. She started the correspondence work also led him to publish multiple arti­ course-call ed Hygieia College-in 1980. cles and books, and several plant species By late 2001 , there were approximately bear his name. 1,000 students from around the world "Probably the greatest legacy of John enrolled in the course. Thieret is his continuing influence on According to Kathi Keville, director John W. Thieret those he encountered who wished to learn of the American Herb Association and about plants," said Robert Naczi, Cura­ author of several books on herbs and 1926-2005 tor of the Claude E. Phillips Herbarium aromatherapy, "Jeannine Parvati was a nowned botanist John W. Thieret, at Delaware State University (e-mail, May midwife not only for all the babies she PhD, passed away on December 7, 26, 2006). "John was a gifted teacher brought into this world, but of the spirit. 005, at the age of79.1 His lifelong whose enthusiasm for all aspects of plants She encouraged everyone-those who ru was infectious. Through sharing his deep dedication to the botanical field resulted attended her workshops, read her books, in contributions to taxonomy, education, botanical knowledge, quick wit, and or were her friends-to develop deeper research, and botanical literature. attention-getting (often unconventional) and more hones t relationships with their Dr. Thieret was born August 1, 1926, demonstrations and stories, John managed families, friends, the earth, and most in Chicago, IL. 2 He earned his bachelor's to communicate passion and accurate importantly, with themselves. and master's degrees in botany from Utah science to generations of students, natu­ "One of her skills was as a wordsmith, State University (in 1950 and 1951, respec­ ralists, and other professional botanists." cleverly pointing out how the very words tively) and obtained his PhD in botany James Reveal, PhD, Professor Emer­ we choose, personally and as a society, from the University of Chicago in 1953.3 itus at the University of Maryland, to express ourselves, reveal much about He began his career serving as Curator of commented that Dr. Thieret's botanical one's true nature," Keville continued. "She Economic Botany at the Field Museum of knowledge encouraged many organiza­ articulated this in her poetry and books on Chicago from 1954-1961. He then entered tions and individuals to seek his counsel healing. Our herbal community has lost a academia, teaching at the University of (]. Reveal, e-mail, May 24, 2006): "John guiding light. My sadness at her pass ing is Southwestern Louisiana in Lafayette from was the person the Flora of North Amer­ eased knowing how many lives she touched, 1961-1973. He later served as Professor of ica Committee turned to whenever they and will continue to touch, through her Botany at Northern Kentucky University needed someone to write a treatment of work" (e-mail, April 27, 2006). (NKU) from 1973-1992, after which he some group that no one else particularly Gladstar echoed such sentiments of acted as that institution's Professor Emeri­ knew anything about. Foremost to me Ms. Parvati Baker's speaking powers and tus of Botany. perso nally was his knowledge of botanical

74 I HerbaiGram 71 2006 www.herbalgram.org In Memoriam

explorations and discoveries in the South­ technology in which wastewater passes for his passion for working on affordable east; he was a valuable resource whenever through a series of ponds that use algae sanitation. As a child in rural Califor­ I was working on the subject." photosynthesis rather than electro­ nia, he witnessed the choking death of a Dr. John Thieret is survived by his wife mechanical aeration devices to aerate the schoolmate from a roundworm infection Mildred, his 5 children, 7 grandchildren, water. The algae-produced oxygen allows caused by poor sanitation. While serving and 5 great-grandchildren.1 HG aerobic bacteria to break down contami­ as a hospital administrator in Europe after -Courtney Cavaliere nants in the water. Oswald designed well World War II, he coordinated the care over 100 wastewater treatment facilities of patients suffering from the effects of References around the world. I contaminated water. I. Eshbaugh WH. John Thieret: A brief "Bill Oswald has contributed to waste­ When he came home, Oswald studied biography. Lloydiana. 2006: 10;2. water treatment, and hence to public at UC Berkeley, earning a degree in civil 2. Hansel M. John Thieret, bota- health, in the less developed world, more engineering in 1950. He stayed on to get a nist, co rnersrone at NKU. Kentucky than anybody else I know," said Gedaliah doctorate in sanitary engineering, biology, Post. December 10, 2005. Available at: http://news.kyposr.com/apps/ Shelef, professor emeritus of Israel's Tech­ and public health in 1957, the same year pbcs.dll/arricle?AID=/200512 10/ nion Institutes of Technology, an expert he joined the Berkeley faculty. In 2001 NEWS02/512100346/-1 /BACK01. on wastewater engineering and a former Dr. Oswald joined Lawrence Berkeley Accessed May 18, 2006. student of Oswald's. 1 National Laboratory as a senior staff scien­ 3. Kentucky Academy of Science Superla­ Many benefits flow from an algae tist.1 ·4 He retired from teaching at Berke­ tive Awards page. Kentucky Academy of pond treatment system: the algae can ley in 1990, but continued his research Science Web site. Available at: http://www. be harvested as a protein-rich food for and engineering practice as an entrepre­ kyacademyofscience.org/about/superla­ animals; the cleansed water can be reused neur and a scientist at LBNL until the last tive_awards.html. Accessed May 24, 2006. for irrigation or as a coolant; the sludge days of his life. I from the bottom of the pond can be In 2005, the International Society for added to the soil for a high humus fertil­ Applied Phycology (the branch of botany izer; microalgae can absorb heavy metals; dealing with seaweed and algae) presented settling and digestion chambers can him with a lifetime achievement award. produce methane for use as a fuel; and Colleagues from around the world have using microalgae to treat wastewater saves also nominated him for the 2006 Stock­ energy and reduces greenhouse gas emis­ holm Water Prize. I sions. And since algae can do all this work "William Oswald developed and in seawater, precious freshwater can be demonstrated sustainable technology conserved. 2 decades before sustainability was a buzz­ Dr. Oswald's largest AIWPS design was word," said Bailey Green, research scien­ for the purpose of purifying the Ganges tist at LBNL and a colleague of Oswald's William J. Oswald River, which is heavily used for daily reli­ for the past two decades. "H e was a man gious bathing and drinking.3 ahead of his time, and a humanitarian 1919-2005 Oswald's inventions went beyond treat­ above all else." I HG lliam J. Oswald, PhD, a scien­ ing wastewater. Early in his career, he -Nancy Dennis tist who pioneered many ways demonstrated a life support system for References W to use algae-from treat­ the US Air Force space program that ing wastewater and generating energy to used algae to purify astronaut waste while 1. Yang S. William Oswald, pioneer in the use of algae ro treat wastewater, dies at facilitating space travel-died of pancre­ producing distilled water and oxygen.2 86 [press release]. UC Berkeley Media atic cancer on December 8, 2005, at his Dr. Oswald's interest in the nutritional Relations; December 19, 2005. Available value of algae led to the development of home in Concord, California. He was at: http://www. berkeley. ed u/news/ media/ 86. Dr. Oswald was a professor emeritus production systems for spirulina (Arthro­ releases/2005/ 12/ 16_oswald.shtml. Accessed in civil and environmental engineering spira maxima Setchell & Gardner, Oscil­ April 13, 2006. and a researcher at the Lawrence Berkeley latoriaceae) and dunaliella (Dunaliella 2. Oswald WJ. My sixty years in applied algol­ National Laboratory (LBNL). salina [DunaJ] Teodor, Dunaliellaceae). ogy. journal ofApplied Phycology 2003; 15:99- Oswald was among the first engineers to One of his graduate students set up the 106. Available at: http://esd.lbl.gov/ESD_ staff/oswald/pdf/03_My_Sixty_ Years_i n_ study the symbiotic interactions between first spirulina production plant in the United States. Oswald also assisted in the Algology.pdf. Accessed April 13 , 2006. algae and bacteria in wastewater treatment 3. Sanders R. Saving the "Mother of India": establishment of a pond system growing ponds. For over 60 years he combined Berkeley Technology May Clean Up Ganges biological and engineering knowledge to dunaliella for commercial production of River. Berkeleyan. November 18 , 1998. create many valuable applications for the glycerol and beta-carotene.2 Ava ilable at: http://www. berkeley.edu/news/ ability of algae to make remarkably effi­ Born in King City, California, on July berkeleyan/ 1998/1118/india.html. Accessed cient use of solar energy. 6, 1919, Oswald grew up on an arid April 13, 2006. The most widely used of the applications ranch where his interest in water, agri­ 4. Martin D. W. J. Oswald, 86, Algae Mira­ cle Worker, Dies. The New York Times. he developed is the Advanced Integrated cultural production, and human health December 21, 2005;0bituaries:C20. Wastewater Pond Systems (AIWPS), a began. Two early experiences accounted www.herbalgram.org 2006 HerbaiGram 71 I 75 In Memoriam

numerous clients in this direction, includ­ on the one hand, and many scienrists and ing large pharmaceutical companies policy makers at the FDA on the other, as well as small-venture startups," said especially at a pivotal time in the develop­ Mark Blumenthal, Founder and Execu­ ment of the herb movement," Blumenthal tive Director of the American Botanical said. Council (ABC). ABC Board of Trustees Chairperson By 1992, Dr. Leaders founded Leaders Peggy Brevoort was close to Dr. Leaders Group, Inc., and he served as consultant for many yea rs. "Floyd was a visionary and for the former Office of Alternative Medi­ doer," she wrote. "He opened doors for cine (OAM) at the National Institutes of me to new worlds and ideas and concepts Health (NIH), now called the National that changed how I dealt with our busi­ Floyd Edwin Center for Complementary and Alterna­ ness [East Earth Herbs, now A.M. Todd tive Medicine.1 Botanicals] and its vision. He encour­ Leaders, Jr After the passage of the Dietary Supple­ aged some of the most creative thinking ment Health and Education Act in 1994, I have ever done. He was one of the first 1931-2006 Dr. Leaders was one of the principle perso ns to understand how our fl edg­ he herbal medicine movement lost people to motivate OAM to sponsor and ling herb industry could work with rather an es teemed colleague and rrue organize a two-day conference on botani­ than against a complicated, established friend with the passing of Floyd cal medicine, the first conference of its hea lth care system. And he dedicated his T kind sponsored by the US government, a energies and business sense to building Edwin Leaders, Jr, PhD, at age 74. Follow­ ing a lengthy illness, he died February 26 watershed moment in the history of the those bridges." [P. Brevoorr e-mail to M. in Columbia, Maryland.! botanical medicine movement. Blumenthal, February 26, 2006.] "Floyd was a monumental figure in the Dr. Leaders became a catalyst to increase Dr. Leaders is survived by his wife of 30 research and drug development of botani­ communication and cooperation among years, Madeline Van Hoose of Montgom­ cal products in the United States. He various segments of the botanical medi­ ery Village, Maryland; his daughter, Terra was a mentor and a colleague, and most cine industry, researchers, and the federal Leaders Singletary of Midland, Texas; and imporrandy-a friend," said Freddie Ann government. his grandson. I HG Hoffman, MD, a former Food and Drug "In this role, he assisted researchers, -Cynthia Crimmins clinical investigators, federal agencies, and Administration (FDA) official and consul­ References tant on botanical drug approvals. the industry to understand not only the Dr. Leaders was born in Deniso n, need for carefully designed studies and I. Floyd Edwi n Leaders, Jr, Medical Firm 1 data management, bur also the rigor­ Founder. Washington Post. March 11, Iowa, in 1931. He graduated from Drake 2006: B6. University in 1955 with a Bachelor of ous requiremenrs for US [FDA] develop­ ment and approval," Dr. Hoffman said. 2. Botanical drug advocate Dr. Floyd Science in Pharmacy and attended Iowa Leaders, ] r dies after long illness [press State University where he received his "Through his patience and powerful nego­ rel ease]. Austin, TX: American Botanical Master of Science in Pharmacology in tiation skills, Dr. Leaders was successful in Council; February 26, 2006. 1960 and his Doctorate in Pharmacology assisting sponsors in filing Investigational in 1962.2 New Drug applications for heterogeneous Dr. Leaders became an assistanr profes­ [i.e., chemically complex] botanical prod­ sor of pharmacology at the University of ucts with the FDA Center for Drug Evalu­ Kansas Medical School, but "in 1967, he ation Research." left academia to join Alcon Laboratories He served as co-chair of botanical drug in Fort Worth, Texas, and continued to development workshops sponsored by the move up through the ranks of the phar­ Drug Information Association, the FDA, maceutical industry, serving as Director and the NIH. His work also contrib­ of Resea rch Service at Schering-Plough, uted to the "scienrific underpinnings" and then Director of R & D at Pennwalt for the FDA Cenrer for Drug Evaluation Corporation," Dr. Hoffman said. Research Guidance Document on Botani­ In 1977, Dr. Leaders founded Techni­ cal Drugs.2 Tom Ferguson cal Evaluation and Management Services, In 1997, Dr. Leaders formed Botanical Inc. Based in Dallas, the conrract research Enrerprises in Rockville, Maryland, and as 1943-2006 organization was "one of the first to Chairman and CEO, he worked to make run clinical rrials for the pharmaceuti­ commercial agreements with companies om Ferguson, MD, a physician cal industry to meet the FDA's regulatory inrerested in developing botanical drug who persuaded people to take standards," according to Dr. Hoffman. products.2 T charge of their own health, died "Dr. Leaders was particularly interested "Dr. Leaders was instrumenral in help­ Apri l 14, 2006, at the UAMS medical in improving the prospects for companies ing create a significanr bridge of commu­ center hospital in Litde Rock, Arkansas, interes ted in pursuing the drug approval nication and understanding between the where he was undergoing treatment for avenues for botanicals, and he mentored herb industry and botanical researchers, multiple myeloma. He was 62.

76 I HerbaiGram 71 2006 www.herbalgram.org In Memoriam

Dr. Ferguson straddled the worlds of Johnson Foundation, an Adjunct Associ­ can decide for themselves how they want mainstream and alternative medicine, ate Professor of Health Informatics at the to proceed ." Castleman further explained empowering consumers not to ignore the University of Texas H ealth Science Center that although Ferguson was an MD, he dictates of medicine, but to fully under­ at Houston, a Senior Associate at Boston's never considered mainstream medici ne as stand them and all other appropriate Center for Clinical Computing, and most­ inherently superior to other healing arts. avenues of treatment and prevention. He recently an adjunct faculty at the Univer­ "Tom had deep respect for herbal medi­ argued that informed self-care is the start­ sity of Arkansas Medical Sciences Center, cine. He was well aware that it was the ing point for good health and worked to where he initiated a patient-centered, qual­ basis for much of modern pharmacology. encourage medical professionals to treat ity improvement program at the Myeloma And he felt a special affinity for herbal clients as equal partners in achieving Institute for Research and Therapy. 2 medicine because so much of it was self­ better outcomes. His goal was to change When Dr. Ferguson became ill 15 years care.,, the entrenched practices of the conven­ ago, he applied the principles he had advo­ Peggy Brevoort, a pioneer in the herb tional top-down hierarchy of the doctor­ cated to himself. According to his wife, community and currently President of patient relationship. Meredith Mitchell Driess, "He kept with the American Botanical Council Board After earning his medical degree from the traditional party line and did what of Trustees, said, "Tom and I were only a the Yale University School of Medicine the doctors told him he should do, bur month apart in age and had a special bond in 1977, he launched a prolific career tweaked their advice in his own way. He as cousins; I think of him always as gentle, in consumer-focused medical writing as read widely, worked out his own doses kind, giving, full of humor and intelli­ founder of Medical Self Care Magazine and was not afraid to experiment; when gence and life; always caring for others and as the health and medical editor for he heard about a clinical trial involving before himself, even in his illness." the Whole Earth Catalog in the 1970s. In thalidomide, he called the drug company Dr. Ferguson is survived by his wife, 1979, he was interviewed by Dan Rather and told them he wanted to be in on it. H e Meredith, of Austin, Texas; his stepdaugh­ on 60 Minutes, introducing 40 million lived far longer than most people with this ter, Adrienne Dreiss of Manhattan; his television viewers to what was then widely disease do."4 mother, H elen Williams Ferguson of Coos called the "self-care revolution."! Dr. Ferguson was born in Ross, Cali­ Bay, Oregon; a brother, Fergus Mclean of From 1980 to 1996, he authored or fornia, on July 8, 1943, but grew up in Eugene, Oregon; and a sister, Kirpal Kaur co-authored over a dozen books,2 includ­ Coos Bay, Oregon. He did his undergrad­ Khalsa of Espanola, New Mexico. HG ing Health Online: How to Find Health uate work at Reed College in Portland -Nancy Dennis Information, Support Groups and Self Help and received a master's degree in creative Communities in Cyberspace, a book Dean writing from San Francisco State Univer­ References Ornish, MD has called "the Bible of sity before pursuing medical studies. He I. "What they're say in g about Tom Fergu­ self-care information on the lnterner."3 moved to Austin, Texas in 1983. 2 son" page. docrom.com Web sire. Avai l­ With the rising popularity of the Inter­ "While he wasn't an 'herb person,' Tom able ar: hrrp://docrom.com/abour/saying. hrml. Accessed May 2, 2006. net, Dr. Ferguson's long history of advo­ believed deeply in empowering people 2. Tom Ferguson, M.D . Austin American­ cacy for information-empowered medical to take care of their medical needs as Statesman. April 19-22, 2006. consumers positioned him to be a leading much as possible," said Michael Castle­ 3. About page. docrom.com Web sire. proponent of online health information man, a former editor of Ferguson's Medi­ Available ar: hrrp://docrom.com/abour/. resources. He called laymen who used cal Self Care magazine. "To that end, he Accessed May 2, 2006. Internet medical resources "e-patients." was very supportive of the dissemina­ 4. Brozan N. Dr. Tom Ferguson, Who In 1993, he organized the world's first tion of medical knowledge-all medi­ Urged Self-Education, Dies ar 62. New conference devoted to computer systems cal knowledge: mainstream, alternative, York Times. April 24, 2006. designed for medical consumers. In 1998, herbal-you name it. His mantra was: he became editor and publisher of a news­ give people accurate information and they letter called, "The Ferguson Report: the Newsletter of Consumer Health Infor­ matics and Online Health."4 In 1999, he was one of 4 people to be recognized as an "Online Health Hero," an award given Correction by the Intel Corporation's Health Initia­ An article in HerbalGram 69, "Jimson Weed: History, Perceptions, Tradi­ tive Project. 2 In 2000, Dr. Ferguson began teach­ tional Uses, and Potential Therapeutic Benefits of the Genus Datura," omitted ing the first-ever medical school course contact information for the authors. Readers may contact the primary author, in Consumer Health Informatics at the Kofi Busia, by telephone at 00233242128799 and by e-mail at [email protected]. University of Texas Health Science Center gh/ or Kofi_ [email protected]. Fiona Heckles may be contacted by tele­ at Houston. In early 2001, he joined the phone at 01992587021/07830195745 and by e-mail at [email protected]. Pew Internet and American Life proj­ The American Botanical Council regrets this omission and apologizes for any ect as Senior Research Fellow for Online inconvenience this may have caused. Health.1 At the time of his death, he was also a consultant to the Robert Woods www.herbalgram.org 2006 HerbaiGram 71 I 77 August 28: Materia Medica of the American [email protected]. Web site: www.congress. 2006 West. Laurel, MD. Michael Moore, founder of peunova.ru. the Southwest School of Botanical Medicine, September 22-24: Green Nations Gather­ August 5: A Workshop: Botanicals as "New" will conduct this !-week workshop, at the Tai ing. Rowe, MA. David Winston will be joined Drugs. Arlington, VA. This workshop is an Sophia Institute. Materia Medica of the Amer­ by Doug Elliot, Rosemary Gladsrar, Ceci li a introduction to the drug development process ica n West wil l feature Moore's favorite plants Mitchell, Susa n Weed, Elena Avila, and many for naturally complex or heterogeneous prod­ and clinical applications. He will discuss their other superb teachers at the beautiful Rowe ucts, such as botanicals. Experts in the field habitat, environmental risks, and ava ilability. Conference Center. Special events include wi ll address the current status of US drug To register or for more information, contact an emporium, demonstrations, sweat lodge, development for botanical drugs. Phone: 202- the Tai Sophia Institute at 410-888-9048 ex t. storytelling, and music. Contact: Pam Mont­ 545-6843. Web si te: www.phcog.org/Annuai­ 6611. Web site: www.tai .edu. go mery, 802-293-5996. Web site: www.green­ Mtg/Washington.html. September 4: Field Lecture Workshop: An nations.org. August 5-6: Rutland Biodynamics Confer­ In-depth Exploration of Regional Medici­ September 22-24: Southeast Women's ence. Oakham, UK. David Winston nal Plants. Laurel, MD. Michael Moore, Herbal Conference. Hendersonville, NC. will be the keynote speaker at this evenr founder of the Southwest School of Botanical Red Moon Herbs is proud to present the 2nd in rural Oakham. He will teach classes on Medicine, will conduct this !-week workshop, Annual Southeast Women's Herbal Confer­ the Duyukta-A Cherokee Look at Health, at the Tai Sophia Institute. The workshop ence. The goal of this event is to help women Spirit, and Life; The Differential Treatment of includes visits to regional parks and focuses deepen their connection with the Earth, the Depression and Anxiety; and The Alchemy of on plant personalities, constituents, historical plants, each other, and their own bodies. Herbs. Contact: Rutland Biodynamics, Ltd., uses, and therapeutic applications. To regis­ Acclaimed author Srarhawk wi ll serve as the Town Park Farm, Brooke, Oakham, Rutland ter or for more information, co ntact the Tai conference's keynote speaker. For further LEI5 8DG. Phone: 44(0)-1572-757440. Web Sophia Institute at 4 10-888-9048 ext. 6611. information or to register for this event, visit site: www.rutland bio.com. Web site: www.tai.edu. the Web site www.redmoonherbs.com. Phone: August 5-9: Natural Products on Target: September 12-14: 2nd Annual Inside Beauty 888-929-0777. The 47th Annual Meeting of the Ameri­ Trade Show and Conference: "Cultivat­ October 2-9: Ethnobotanical Tour-Botan­ can Society of Pharmacognosy. Washing­ ing the Beauty Market from the Inside ical Medicines from the Amazon with ton, DC. Please join us at the meeting for Out." New York , NY. INSIDE BEAUTY Optional Extension to Machu Picchu Octo­ an exciting series of presentations covering brings together professionals from the cosmet­ ber 8-12. Sponsored by the American Botani­ contemporary developmenrs in natural prod­ ics, personal care, fragrance, nutraceuticals, ca l Council, the Texas Pharmacy Associa­ ucts chemistry, biosynthesis, drug discovery, cosmeceuticals, botanicals, and functional tion Foundation, the ACEER Foundation , and drug development, and N IH Road Map initia­ foods industries to platform innovative new West Chester University of PA. Faculty: Jim tives. Phone: 301-846-1943. Web site: www. products designed to both promote beauty Duke, PhD; Steven Foster; and Sue Musralish, phcog.org/AnnuaiMtg/Washington.html. and address overall health and wellness. The RN. For more information, please visit the August 17-18: The International Confer­ educational conference program covers the Web site at http://www.herbalgram.org/ ence & Exhibition of the Modernization of latest marketing trends, scientific research, defaulr.asp'c=ed_tours or contact Marguerite Chinese Medicine & Health Products. Wan product innovation, and thoroughly ex plores Gould at [email protected] or by phone at C haim, Hong Kong. This year, the compre­ the opportunities and challenges facing this 601-738-0477. hensive 2-day conference will feature 3 excit­ growing market sector. E-mail : www.inside­ October 3-7: Contributions of African ing forums. It includes a CEO forum on the beaury.com. Botanica to Humanity 2006. N 'Zerekore, development of strategies to international­ September 14: Herbal Therapies for the Republic of Guinea, West Africa. This event ize Chinese medicines. A second forum will Eyes, Ears, Nose, & Throat. Washing­ will study in detail the pharmacological, review advances in Chinese medical research ton, NJ. The purpose of this class is to phytochemical, and ge netic as pects of Afri­ on infectious diseases such as SARS, bird flu, discuss simple but effective clinical proto­ can boranica to clarify rhe intimate structure and hepatitis. The third forum focuses on cols for treating common ai lmenrs affect­ of plants' molecules and to identify inreresr­ quality control, regulations, and the R&D ing the eyes (co njunctivitis, blepharitis), ears, ing characteristics of plants used for health of modern Chinese medicinal products. E­ (otitis media), nose (si nusitis, allergic rhinitis), maintenance. This symposium wi ll also give mail: [email protected]. Web site: www. and throat (sore throat, laryngitis, tonsillitis). planr reproduction specialists the opportu­ icmcm.com. Contact: Cathy Garland, Herbalist & Alche­ nity to share their views about the agronomi­ August 19: Planting the Future: A Confer­ mist, Inc. Phone: 908-689-9020 ext. 101. cal aspects that can influence the content in ence on the Cultivation, Preservation & E-mail: [email protected]. Web bio-active compounds in medicinal, aromatic, Uses of Native Medicinal Plants. East site: www.herbalist-alchemisr.com. and food plants. Web sire: http://www.bora­ Barre, VT. Some of the many presenters for September 16-19: The Conference: the niqueafricaine.com/. Phone: 506-455-41 10. this conference include Rosemary Gladstar, Council for Responsible Nutrition (CRN) October 5-8: 5th Annual Traditional Pam Montgomery, Deb Soule, Bob Beyfuss, 2006 annual symposium on dietary supple­ Chinese Medicine Conference. East Ruth­ Matthias and Andrea Reisen, Kate Gilday, ments. Cambridge , MA. The Conference erford, NJ. "Building Bridges of Integration Don Babineau, and Nancy and Michael Phil­ will feature sess ions on regulatory, scienrific, for Traditional C hinese Medicine-Trans­ lips. The conference will rake place at the and business-building issues, co mbined with formation : Spirit in Healing" is a landmark Sage Mounrain Herbal Retreat Center. Activi­ networking opportunities for dietary supple­ educational forum on traditional C hinese ties include classes on sustainable practice of menr leaders and managers. CRN Board medicine for Eastern and Western healthcare herbal medicine, "at risk" plant cultivati on, Member John Venardos of Herbalife Inter­ profess ionals interested in exploring this medi­ plant identification walks, and related topics. national of America, Inc., wi ll serve as this cal system's growing role in integrative and For more information and registration forms, year's conference chairman. For more infor­ complementary healthcare. It will take place visit www.unitedplantsavers.org. Phone: 802- mation about The Conference 2006 and other at the Sheraton Meadowlands Hotel, East 476-6467. upcoming CRN educational programs, please Rutherford, New Jersey, just outside NYC. August 21-24: Quality and Safety and visit http://www.crnusa.org or contact Judy Visit www.tcmconference.org or call 1-888- Processing Conference. Oxford, MS. The Blatman at 202-204-7962. TCM-6909. purpose of this conference is to review, discuss, September 21-23: International Congress on October 6-8: Natural Products Expo East: and explore methods for determining the iden­ Complementary, Holistic & Naturopathic Educational seminars. Baltimore, MD. tity, purity, quality, and processing of botani­ Medicine (CHNM) and Expo "World Contact: Cathy Garland, Herbalist & Alche­ ca l material. Topic areas wi ll include such Health." Samara, Russia. This evenr wi ll mist, Inc., 908-689-9020 ext. 101. E-mail: issues as authentication, cultivation, collec­ address some cu rrent questions of CHNM [email protected]. Web site: tion, and post-harvest practices for produc­ developmenr both in Russia and abroad. www.herbalisr-alchemist.com. ing quality planr material, as well as chemical Participants will have the opportunity to October 9-15: CancerGuides. Bloomingdale, and toxicological methods for quality/safety become familiar with and discuss the most IL. CancerGuides is the world's first and only assessment. Phone: 662-915-7821. E-mail: interesting CHNM techniques in workshops comprehensive training program in integra­ ikhan@olem iss .edu. and classes. Phone: +7 846 2705392. E-mail: rive oncology. T his unique interdisciplinary

HerbaiGram 71 2006 www.herbalgram .org course teaches health professionals and patient The French Society of Antioxidants (SFA}, nal use of saffron. Organizers for the event advocates ro work coll aborar ively with people the International Society of Antioxidants in are the Center of Excellence for Special Crops with cancer ro create safe, effective, humane, Nutrition and Health (ISANH), the Japa­ (CESC) Faculty of Agriculture and Ferdowsi individualized programs of care that integrate nese Society of Antioxidants (JSA}, and rhe University of Mashhad (FUM) under rhe rhe best of complementary and alternative Malta University are pleased ro announce their auspices of the International Society for Horti­ approaches with conventional therapy. For third international confe rence and exhibition. cultural Science (ISHS) Section of Medicinal more information, please visit the Web sire Fo r more information, contact Dr. Sandrine and Aromatic Pl ants. Web sire : http://saffron­ www.cmbm.org. Rodriguez. E-mail: [email protected]. ir.um.ac.ir/. O ctober 16-19: International Symposium Web sire: www.isa nh.com. October 29-November l : T he 4th Inter­ on Pomegranate and Minor Mediterra nean October 26-29: American Herbalists Guild national Conference o n Mecha nism of Fruits. Adana, Turkey. T his event, which wi ll be Conference: From Expert Consensus to RCT: Action of Nutraceuticals (ICM AN4). Tel­ held on rhe campus ofCukurova University, will C reating an Evidence Base in Clinical Botan­ Aviv, Israel. The conference will deal with feature lectures and workshops on issues relat­ ical Medicine. Boulder, CO. David Winsron the latest developments in dietary and endog­ ing to pomegranates and Minor Mediterranean will be joined by so me of the top clinical herb­ enous sources of nurraceuricals; the results plants. Topics include plant physiology, current alists from the Un ited Stares, Canada, and of cellul ar, molecular, and animal studies in resea rch, harvesting, economics, and pests and England for 2 and a half days of herbal educa­ diabetes, cancer, neurodegenerarive disease, diseases, among others. For more informa­ tion at irs best. Contact: Tracy Romm, 203-272- cardiovascular and in flammatory disorders; tion, contact Dr. Ahsen lsik Ozgi.iven; Phone: 6731. E-mail: ahgoffice@ea rrhlink.ner. Web proreomic-genomic developments; and ami­ (9 0}3223386564. Fax: (9 0)3223386388. E­ site: www.americanherbalistsguild.com. aging opportunities . Web sire: http://www. mail: [email protected]. Web site: www.cu.edu. October 28-30: The 2 nd Internationa l evetopf.org/icman4. tr/fakulteler/zf/bkb/ispm/. Symposium on Saffron Biology and Tech­ October 26-27: Polyphenols Applications nology (ISSBT). Mashhad, Iran. T his sympo­ More calendar listings at in Pharmaceutical, Food and Cosmetic sium is intended for those involved in rhe Industries Conference. La Veletre, Malta. productio n, processing, marketin g, or medici- www.HerbaiGram.org

In this depanmenr of HerbaLGram, we li st resou rces such as publications, organizations, seminars, and networking for o ur readers. A li sting in this section does not constitute any endorsement or approval by HerbaLGram, ABC, or its Advisory Board.

T he H erbal Dispatch-Monthly publication at http://www.kbs.ku.edu/people/sraff_www/ production. Guid e also gives overview of of the Medicinal Botanical Program at Moun­ k i ndscher/ ech i nacea/ maps2. h rm. major biodiversity issues facing key business rain Stare University in Beckley, WY. Provides Master's Degree in Integrative Health Stud­ sectors and supplies case-studies of various description of Program's educational offerings, ies ava il able through rhe Ca li fo rnia Institute IFC-client businesses th at have handled biodi­ including monthly workshops and outreach of Integral Studies (CII S) in Sa n Francisco, versity iss ues in their operations. Available at activities, plus articles highlighting laresr CA. This 2-yea r nonclin ica l program exa m­ http:/ /www.ifc.org/i fcex r/envi ro. nsf/Content/ research on specific herbs. Covers cultivation, in es and integrates complementary, alterna­ BiodiversityGuide. processing, and preventive and therapeutic uses tive, and conventional hea lrhca re beliefs and Find a Professional-a service of H ealth­ of herbs and vegetables. Topics from recent sys tems from Eastern, Western, and indige­ World Online-Helps connect lnrernet issue include plant profiles of bloodroot and nous traditions. Program is primarily intended users with integrative healrhcare professionals Jack-i n-the-pulpit. Free subsc ription to printed for graduates interested in employment as through a free searchable database. Database or electronic version ava il able by e-mailing to integrat ive health administrators, integrative is divided into 16 different medical fields, [email protected]. Article submis­ researchers, policy makers, or consu ltants. including herbalism, nutritional medicine, sions and comments are welcomed. Students may enroll as ei ther fu ll or parr-rime dentistry, and acupuncture/oriental medicine. Ka mpo Medicine C lass. Keio Uni ve rsity participants at the starr of both spring and The directories of one or more leading profes­ Medica l School in Japan has posted a derailed fa ll semesters. M any classes are offered during sional medicine organizations within each overview of the hisrory, uses, and effective­ evenings ro accommodate sc hedul es of work­ field are ava il able, through which users can ness of Kampo medicine online as a "Kampo ing students, parents, or health professionals. sea rch for CAM physicians by name, city, zip Virtual C lass," available at http://web. sc.itc. C IIS is a small private universi ty encouraging code, area code, state, or counrry. Informa­ keio.ac.jp/ kampo/vc/index .hrml. Ka mpo spiritual and practical approaches to intellec­ tion on over 17,000 professionals is accessible represents rhe evolution of Chinese medicine tual life. More information at www.ciis.edu/ through this database. Web page also provides after it was introduced into Japan in the 5th academics/ih l.html. tip sheets and Web links to help in the search century CE. About 75% of Japanese doctors NWFP Digest- Free monthly e-newsletter and selection of CAM practitioners. "Find a reportedly incorporate Kampa medicines and of rhe Non-Wood Forest Products program Professional" Web page ava ilable at http:// techniques within their practices. This online (NWFP) of rhe United Nations' Food and healrhreferral.com. tutorial, avail able to entire public, covers Agriculture Organization (FAO). A compil a­ N orth American Institute of Medical differences between Kampo and traditional tion of articles and items from a wide range of H erbalism (NA IMH), in Boulder, CO, offers C hinese medicine; a hisrory of how rhe formu­ international sources, concerning all aspects new onsite and distance ed ucation courses lations were deri ved; the methods used for of non-wood forest products. Topics include in medical herbalism and clinical nutrition. prescribing Kampa medicine, including how specific featured products, countries associ­ Courses are ava ilable for continuing educa­ ir is integrated with Western medical models; ated with NWFP production, current news tion credit, and many are offered as certificate a formula catalog; and an herb catalog. and events, employment opportunities in programs. Distance-learning courses are writ­ Echinacea Species Distribution Maps are the NWFP field, literature reviews, Web sire ten and reviewed by practicing clinical herb­ now available online, plotted by US county profiles, etc. Subscriptions and back issues ali sts and professional herbal educators, and and Canadian census d ivision, showing range at FAO Web sire: www.fao.org/fores try/ materials include edited aud iotapes of class­ of distribution of all 9 species in the genus sire/12980/en. room lectures. In addition ro offering course­ Echinacea as compiled by plant ecologist G uide to BioDiversity for the Private work, AIMH publishes textbooks of medi­ and conservation biologist Kell y Kindscher, Sector- ew online publication from Inter­ cal herbalism and orher ropics, prints a quar­ PhD, at the Uni versity of Kansas. Data were national Finance Corporation (I FC). Features terly journal tided Medical Herbafism, and compiled from herbarium records and ve ri fied information and examples of how businesses in operates a payment-by-sliding-scale holistic by Dr. Kindscher and colleagues for accuracy emerging markers ca n perform and profit from center called rhe Evergreen Center. NA IMH and currency. The resea rchers did nor include environmentally-consc ious practices. Provides promotes the Vital ist Tradition of healing, herbarium specimens for cultivated vouchers businesses with understanding of responsi­ emphasizing the inter-connectedness of mind, (from the state of Washington, for example} or bilities roward biodiversity, and explains the body, spirit, and nature. Information available escapees (such as E. angustifo lia along railroad benefits ro be derived through proper risk at www.nai mh.com. tracks in downtown Sr. Louis) . Maps available management and promotion of sustainable www.herba lgram .org 2006 HerbalGram 71 I isrs Association of Australia (founded in 1920). herbalists, MDs, nurses, NOs, veterinarians, Employment Deals with all aspects of Medical Herbalism, nutritionists, etc. in the arr and sc ience of Family owned medicinal herb company including laresr med icinal plant research clinical herbal medicine. For more informa­ seeks highly skilled, compassionate findings. Regular features include Austra­ tion, please visit www. herbalsrud ies .org, www. Manager of our Herbal Department. We lian medicinal plants, conferences, conference herbaltherapeutics.net, or contact us at 908- have been ex periencing consisrenr growth and reporrs, book rev iews, rare books, case studies, 835-0822 , or dwherbal. [email protected]. a nd medicinal pl anr reviews. AUD/$95 plus want someone who desires ro share in our AUD/$ 15 if required by airmail. National vision. The ideal candidate must be an active Herbalists Association of Australia, 33 Reserve Other li stener and able to rake direction from our founders. Srreer, Annandale, NSW 2038, Australia. Blessed Herbs prides itself on integrity and HerbalGram: Quarrerly journal published Get Certified with ABC's Herbal Informa­ authenticity so we are look in g for experrise by rhe American Botanical Council. A benefit tion Course. This self-paced online course is in: ar a ll levels of membership in ABC. See page des igned ro help retail employees and multi­ 2 for membership information or join online level distriburors communicate knowledg­ • Anaromy & Phys iology ar www.herbalgram.org. P.O. Box 14 4345, ably wirh cusromers about herbs and dietary • Clinical and/or personal Healing Experi - Austin, TX 78714 . 800-373-7105 or fax 512- supplemenrs. After successfully completing ence 926-2345. 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Please email your resume wirh salary require­ Schools You' ll ger a comprehensive inrroducrion ro ments ro scorr@bl essed herbs.com phyromedicines - researching rhe medici­ David Winston's Center For Herbal Studies nal, culinary and cosmetic uses of herbs, To Offer On-line Course! Until now, David answering AB C members' ques tions, work­ Publications Winsron's rwo-yea r herb studies program was ing wirh medicinal planrs in ABC's 2.5 only available ro a limited number of srudenrs acres of herbal gardens, and preparing herbal American Herb Association Quarterly within commuting distance. Beginning in salves, tinctures or meals. For more informa­ Newsletter: $20/yr. AHA, P.O. Box 1673, September 2006 any serious herb srudenr with tion, ca ll Gayle ar 512-926-4900 or email Nevada C iry, CA 95959. a hi gh-s peed I nterner con necrion will be able [email protected]. Australian Journal of Medical Herbalism: ro parricipare in this unique course. 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~ The AHG Annual Symposium Many Ways of Knowing: is widely regarded as one of the preeminent conferences on Evidence in Clinical botanical medicine, offering over 40 workshops by leading Botanical Medicine practitioners and researchers .

~ Continuing education credits October 27-29, 2006 will be offered for herbalists, nurses, pharmacists, preconference intensives on October 26 acupuncturists, and naturopathic The Millennium Harvest House, Boulder, Colorado physicians.

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