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U.S. Nutraceuticals. LLC 2751 Nutra Lane Eust1s. FL 32726 ©2003 U.S. Nutra. All nghts reserved. USPius Saw Palmeno and Zanth1n'" are trademarks of U.S. Nutra. Individuals, organizations, and companies who share our vision support our goals through membership. The American Botanical Council Invites You to e r------~ Yes, I want to join ABC o1n Pl ease detach application and mail to: American Botanical Council, P.O. Box 144345, Austin, TX 787 14-4345 or join online at www. herbalgram .org To join, please fill out this form or call us at 1-800-373-7105 x 119 0 Individual - $50 or fill out an application online at www.herbalgram.org 0 Academic- $ 100 0 Professional - $150 0 Organization - $250 Membership Leve Is Please add $20 for addresses ourside rile U.S. (Add $20 postage ror international delivery ror above levels.) Individual - $50 Academic- $100 0 Corporate and Sponsor levels. (ContaCl Wayne Silverma n, PhD 512/926-4900, exr. 120. ) Subscription to our highly All Individual membership benefits, acclaimed journal HerbaiGram plus Payment instructions Access to members-only • Online access to HerbCiip Online 0 Charge credit card (Visa or MC only) # ______information on ou r website, critical reviews www.herbalgram.org • Complimentary CD, Herbal exp. dare: ______• HerbaiGram archives Medicine: Expanded Commis (Please include rhe 3-digir number following rhe account# on signature line on back of card.) • Complete German sion E Monographs ($39 value) Commission E Monographs • S100 discount on Ethnobotanical • Herbal Medicine: Expanded Tours with Health Quest Travel 0 Send in vo ice w rhe address below Commission E Monographs Professional - $1 SO 0 Check enclosed • Botanical Booklets All Academic membership benefits, 0 Do nor so li cit or share my co ntact info
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Corporate and Sponsorship country Small to large organizations can receive additional benefits, including the bi-weekly HerbCiip service, and also extend their support to ABC's mission through Corporate or Sponsor level membership. To learn more, please contact Wayne Silverman, PhD, at email [email protected], or 1/800-373-71 OS x 120. Advisory Board Each issue of Herba/Gram is peer reviewed by members of our Advisory Board and other qualified experts before publication. dear Cindy K. Angerhofer, Ph .D. Paul Alan Cox, Ph .D. Pharmacognosist and herbal Director, National Tropical Botanical research consultant, Kennebunk, Garden, Kauai, Hawaii reader Maine lyle E. Craker, Ph .D. John Thor Arnason, Ph .D. Professor, Department of Plant and }\. BC has seen lots of activi ty in the past few months, with good news Professor of Biology, Department of Soil Sciences, University of Biology, University of Ottawa, Massachusetts, Amherst rl.and , of co urse, bad. First, so me of the good. Newsweek (circulation over 2 1 million) Ontario, Canada Edward M. Croom, Jr., Ph.D. Dennis V. C. Awang , Ph.D., Scie ntific and Regulatory Affairs picked up on our cover story on Rhodiola rosea in HerbalGram 56 with F.CI.C. Manager, lndena USA East, Inc., a one-page article in their February 3 edition, summarizing its benefits MediPiant Natural Products Paramus, New Jersey and market potential (" Herbal Stress Buster?"). We had about eight Consulting Services, White Rock, B.C., Wade Davis, Ph.D. interviews and emails wi th reporter Anne Underwood. Unfortunately, Canada Author, ethnobotanist, mention of HerbalGram and ABC were cut for space reasons, but she Manuel F. Balandrin, R.Ph., Washington, D.C. quoted us saying rhodiola has many of the Ph.D. Steven Dentali, Ph.D. elements of bei ng the nex t herbal "s uperstar" - Research Scientist, NPS Vice President of Scientific and good safety record, compelling benefits, and a Pharmaceuticals, Salt Lake City, Utah Technical Affairs, American Herb al growing body of scientific informati on. Frankly, Bruce Barrett, M.D., Ph.D. Products Association, Silver Spring, we do not like to promote herbs as "s uperstars," Assistant Professor of Family Maryland preferring steady, sustainable growth based on Medicine, University of Wisconsin Hardy Eshbaugh, Ph.D reasonable scientific evidence instead of faddish Madison Medical School Professor of Botany & Assistant spikes, but you never know what a reporter is Marilyn Barrett, Ph.D. Curator, Willard Sherman Turrell going to quote from more than an hour of Pharmacognosy Consulting Service, Herbarium, Miami University, combined interviews! T hanks, Anne, for the San Carlos, California Oxford, Ohio accurate, positive report, and thanks also to Bradley C. Bennett, Ph.D. Ad riane Fugh-Berman, M.D. "medici ne hunter" C hris Kilham who first sugges ted the story ro Associate Professor of Biology, Florida Au th or, Assistant Clinical Professor, International University, Miami George Washington University Newsweek. Some more good news: Last fall Family Circle, available at thousands Joseph M. Betz, Ph.D. School of Medicine, Washington, DC of supermarket checkout stands (circulation: 21 million), ran a two Director of the Dietary Supplements Joe Graedon, M.S. Methods and Reference Materials Author, syndicated columnist, radio page piece "Herbal Remedies that Really Work!" based primaril y on Program, Office of Dietary host, Durham, North Carolina material from our forthcoming book, The ABC Clinical Guide to Herbs. Supplements, National Institutesof Mary Hardy, M.D. The message pres umably attempts to counter recent misleading media Health, Bethesda, Maryland Director, Cedars-Si nai Integrative headlines that doubt the benefits of some leading herbs (see below). Peggy Brevoort Medicine Medical Group, Los Now some bad news. In this column, we have ex pressed concerns Co-founder and former CEO of East Angeles, California that many media stori es are biased against herbs, citing recent reports Earth Herb; former President, Christopher Hobbs, LAc., AHG on trials on St. John's wort and ginkgo, plus a highly biased and erro American Herbal Products Herbalist, botanist, licensed neous article in a recent Wall Street journal, as examples. Association; Seattle, Washington acupuncturist, Davis, Cal ifornia Now there's more evidence to support this. On December 9, ABC Francis Brinker, N.D. David Hoffmann, B.Sc., issued a press release on the Cochrane Coll aboration's recent review of Lead Instructor on Botanical M.N.I.M.H 33 controlled clinical trials on gi nkgo for rreatmem of dementia in Medicine for Associate Fellows, Medical herbalist, Santa Rosa, older ad ults, which may be fo und on our website Program for Integrative Medicine, California
4 I Herbai Gram 57 2003 www.herbalgra m.org j Advisory Board HERBAIGRAM (co ntinued) The Jou r nal of the American Botanical Council Steven King, Ph .D. Eloy Rodriguez, Ph.D. Vice President, PS Pharmaceuticals, JamesP erkins Professor of Mark Blumenthal Editor I Publisher Inc., South San Francisco, Cal ifornia Environmental Studies, School of Karen Robin Manag1ng Editor Thomas L. Kurt, M.D., M.P.H . Agriculture & Life Sciences, Cornell University, Itha ca, New York Sean Barnes Art Director Clinical Professor, Department of Internal Medicine, University ofTexas Victor Sierpina, M.D. Steven Foster Associate Editor Southwestern, Dallas AssociateProfe ssor of Fam ily Practice Maureen Jabl inske Proofreader Tieraona low Dog, M.D. Medicin e, University ofTexasMedi cal Chair:United States Pharmacopoeia Branch, Galveston Contributors Dietary Supplements/Botanicals James E. Simon, Ph .D. Farid Alakbarov James Du ke Holly Shimi zu Expert Panel Professor of New Use Agriculture, Dennis V.C.Awang Steven Foster Cynthia Simons Clinical Asst. Professor Director of the Center for New Use Bruce Barrett Diane Graves Barbara Sp ringer Dept of Fa mily and Community Agriculture and Natural Plant Donald Brown Jennifer Greer Lea nna Standish Medicine, University of New Mexico Products, RutgersUn iversity, Jane Buckle Sheila Humphrey Michael Tierra Tom Mabry, Ph.D. New Brunswick, New Jersey Christina Chase Andrew Marston Daniel Wagner Professor of Plant Biochemistry, Beryl Simpson, Ph.D. Steven Dentali Nicholas Oberlies Mansukh Wani Department of Botany, University of C. L Lundell Professor of Botany, Aviva Romm Texasat Austin Department of Botany, University of Gail B. Mahady, Ph.D. Texas at Austin American Botanical Council Staff Research Assistant Professor, Depart S. H. Sohmer, Ph.D. ment of Medical Chem istry & Phar President and Director, Kathleen Coyne Lori Glenn Barbara Springer macognosy, College of Pharmacy, Botanical Research Institute ofTexas, Sales Coordinator HerbCiip Managing Editor Public Relations University of Illinois, Chi cago Fort Worth Jim Costello Tara Hall Coordinator Robin J. Maries, Ph.D. Barbara N. Timmermann, Ph .D. Gardener Special Projects Cecelia Thompson Cheryl Dipper Coordinator Finance Coordinator Director of the Bureau of Resea rch Professor of Pharmacol ogy and and Science, Natural Health Products Toxico logy, College of Pharmacy, Executive Assistant Roger Sleight Kim West Stacy Elliott Webmaster Membership/Development Directorate, Health Products and University of Arizona,Tu cso n Receptionist George Solis Coordinator Food Branch, Health Canada, Ottawa G. H. Neil Towers, Ph.D. Gayle Engels HerbCiip Product1on Margaret Wright Dennis J. McKenna, Ph.D. Professor Emeritu s, F.R.S. C., Botany Education Coordinator Assistant Accounting Coordinator Executive Director, Institute fo r Department, University of British Natural ProductsResearc h; Columbia,V ancouver, Canada W ayne Silverman, Ph.D. Senior Lecturer, Center for Spirituality Arthur 0. Tucker, Ph.D. Chief Administrative Offrcer· and Healing, Universi ty of Minnesota, Research Professor of Ag ricultureand Subscnptions are a benefit of membershrp at evHy level. One year member·shrps: lndrvrdual $50: Minneapolis Natural Resource s, Delaware State Academrc $100: Professronal $150: Organization $250. Add $20 fa,- member·ships outsrde of the Daniel E. Moenman, Ph.D. University, Dover U.S. Student. Senior and Business Member·shrps also available. see ad in this issue. William E. Stirton Professor of © 2003 Amencan Botanrcal Council. ISSN #0899-5648. Printed rn the U.S.A Nancy Turner, Ph.D. Anthropology, University of Professor and Ethnobotanist, The rnformatron in Herba/Grom is intended for educational pU1-poses only and rs not a substrtutron Michigan/Dearborn for the advrce of a qualified healthcar·e pr-ofessronal. Although we attempt to ensure that advertiS Environmental Studies Program, ing in Herba/Gram is tr·uthful and not misleading. the publication of an ad for a product or· William Obermeyer, Ph.D. University ofVictoria, British company in Herba/Gram does not constrtute an endor·sement by ABC of the product or the Vice-President of Research and Columbia, Canada company being advertrsed. Publication of an ad that makes a health clarm or structure-functron Technology, ConsumerLab.com, claim does not necessanly constitute an approval of that claim by ABC. Daniel T. Wagner, R.Ph., MBA, An napolis, Maryland Pharm.D. Samuel W. Page, Ph.D. Dwner, Nutri- Farmacy, Wildwood, Board ofTrustees Director, Division of Natural Products, Penns~vania Mark Bl umenthal (President), Founder and Executive Center for Food Safety and Applied T. Director Andrew Wei I, M.D. Nutrition, U.S. Food and Drug Author, Director of the Program in Michael J. Balick. Ph.D .• Director and Philecology Administration, Washington, D.C. Curator. Institute of Economic Botany, The New York IntegrativeMedi ci ne and Associate Botanical Garden. Bronx. New York Joseph E. Pizzomo, Jr., N.D. Director of the Division of Social James A. Duke (Treasurer) , Ph.D .• Economic Botanist President Emeritus, Bastyr University, Perspectives in Medicine, College of (USDA, ret.) Author. Fulton, Maryland Seattle, Washington Medici ne, University of ~ ERI Cf'N Norman R. Farnsworth (Secretary). Ph.D., Research Mark J. Plotkin, Ph.D. Arizona, Tucso n Professor of Pharmacognosy. Program for Collaborative Author, Executive Director, BoTI'NICAL Research in the Pharmaceutical Sciences. University of Bernd Wollschlaeger, M.D. COUNCIL Illinois at Chicago Ethnobotany and Conservation Team, Family practice physician; Clinical Steven Foster. President, Steven Foster· Gmup. Inc .. Arlington, Virginia Assistant Professor of Medicine and Fam ily Pra ctice, University of Miam i, Educating the Fayetteville. Arkansas John M. Riddle, Ph.D. Fredi Kronenberg, Ph.D .• Director~ Rosenthal Center for School of Medicine, Florida Public on the Professor of History, Department of Complementary and Alternative Medicine, Columbia History, North Carolina State ad hoc advisor: University College of Physictans and Surgeons. New York Use of Herbs & University, Raleigh David M. Eisenberg, M.D. Phytomedicines Varro E. Tyler (Vice President). Ph.D .. Sc.D., Dean and Distinguished Professor of Pharmacognosy Emeritus. School Director, Center fo r Alternative of Pharmacy and Pharmacal Sctences. Purdue Medicine Research, Beth Israel University (deceased) Hospita l/Harvard Medical School, Boston, Massachusetts www. herbalgram.org 2003 HerbaiGram 57 I 5
Echinacea: A Safet~
by Farid Alakbarov, P.h.D. Herbal medicine has a known... , and what is coming to be known
...... ABC loses Beloved Staff Member, Vicki Adams
uesday, O crober 29, 2002, was a sad day from home wheneve r ABC had a project for Vi cki and Evart evenrually retired to Tat ABC when we lost one of our most her and always attended our parries. Florida and, upon his death, Vicki moved beloved and special employees, Vicki Vicki was born in Al exandria, Indiana, in to Austin, Texas, to live wirh her daughter, Adams di ed at age 93. Vicki had worked for 1909. She attended business school and Nan. She is survived by her two daughters, ABC for over 10 years and was a joy ro be worked in a bank before marry ing during seven grandchildren and thirteen great around, with her positive attitude, twin the Depression. She and her husband, grandchildren, and would have shared her kling eyes, and cheerful smile. She was an Eva rt, eve nruall y se rri ed in Ko komo, Indi abundanr love with her first great-grea t inspirati on ro everyone, a role model fo r ana, where they started a photography grandchild, expected in March 2003. how one could live their mature years, and srudio. Vicki was rh e Vicki was quier about her faith in God one of the benefits rhar made ABC a special colorist and reception bur it sustained her rhrough hard rimes and place to work. ist; her husband was guided her in her interactions wirh everyo ne Vicki joined ABC as a volunteer in April rhe photographer. They she met. She gave greatly of her spirit, her of 1992, but was such an asse t ro rh e organ had two daughters, love, and her se nse of humor. She helped us ization rhar she quickly became a regular Nan and Sherry, and to be better people and gave us someth ing employee. For many years she came to the when rh e girls reached to as pire to with her sparkle, her strength, office three days a week to process mail and high school, Vicki and and her kindness. She can never be replaced help our wherever she was needed. T here Adams her husband turned and we will always miss her and remember was never a task that Vicki didn't readily their basemenr inro a ga thering place fo r her with love in our hearts. A and chee rfully pur her hand and heart ro. teenagers. Every Sunday aftern oo n was - Gayle Enge ls Eventually she decided that her health did open house and the basement would fill nor permit her to come to the offi ce on a with happy tee nagers drinking sodas, eating regular bas is, bur she continued ro work popcorn, and shooting pool.
ABC Expands Internship Program for Pharmacy and Dietetic Students
ne of ABC's major educati onal acco m and others about herbal medicine and irs emphasis on resea rch and writing. O plishmenrs is its Internship Program. ro le in roday's society while obtaining help During each intern's orientation, we T he primary goals of rhis program are to in completing so me of our projects. di sc uss wirh them what they hope to ge t provide educati on to university students Currently we have fo rmal arrangements fro m rh e inrernship and rry ro tailor rhe with two universities for studenr ex peri ence ro their specific needs and inrer rotations. T he Uni versity of Texas esrs. We have found that, given th e oppor Coll ege of Pharmacy prov ided two tunity, mosr of our interns have a fa irly clear interns in school year 2001-'02, idea of what rhey wanr to learn while rhey and three in school year 2002-'03 are ar ABC and whar rhey want to do for for six-week ro tations. Southwes t rh eir main project. In facr, rh e first phar Texas Srate Unive rsity Family and macy intern of rhe year, Tiffany Noecker, Consumer Sciences D epartment wanted to design an in-service course fo r provi ded nine dietitians in school pharmacists rh ar would introduce rh em to year 2001-'02 and nine for 2002- herbal medicine. T his is consistenr with one '03 for one-week rotati ons. During of our goals to design a continuing educa rhe 200 1-'02 school year we also ti on (CE) course based on ABC's new book, had three nutrition interns from The ABC Clinical Guide to Herbs. During Texas A&M Uni ve rsity and Texas rh e course of her six-week internship, Women's Unive rsity. T iffa ny wo rked wirh ABC staff to des ign a ABC's Case Mill Homestead had some visitors this past We recently reworked the CE course rh ar is accredited rhrough rhe fall who were also celebrating the birthday of someone curriculum for borh rhe pharmacy Texas Pharmacy Association for 3 credit very special. In the Human Systems garden (from left) and diereric inrernships to improve hours. Currently rh e course is held on-sire are ABC's gardener Jim Costello; Scott Kresge, who owns the ex peri ence for the interns, at ABC and we hope to expand ir to orh er the nursery Emily Mae's Garden Stop in Pen Argyl, Penn make ir eas ier to evaluate whether ve nues this year. sylvania; Ann Wilson, Herb Society of America member learning objecti ves were accom Goals fo r 2003 are to promote and ship chairperson from Austin, Texas; Jim Adams, curator of the National Herb Garden in Washington, D.C.; plished, and achieve more of ABC's marker rh e inrernship program to addi Madalene Hill, the birthday girl and herb horticulturist goals and obj ecti ves . C hanges ti onal schools and to inrroduce the program extraordinaire; Henry Flowers, horticulturist at Festiva l include ex panding the projects to new areas such as journalism, marketing, Hill; and ABC's executive director Mark Blumentha l. fro m which rh e interns ca n select; and inform ati on sciences. A Photo by Wayne Si lverman. updated reading materials; clarified -Gayle Engels learning obj ecti ves; and more
8 I Herba iGram 57 2003 www.herbalgram.org American Botanical Council Website- Come See What's New f you haven't seen rhe ABC website, rion News. We conrinue to mainrain a • direcr access from rhe home page to I
ABC Announces Third African Herb Tour
oin ABC for irs rhird erhnoboranical tour Traditions of rhe Ancienr San C ulture; Physicians, nurses, physician ass istants, J to Africa, " International Health Iss ues Medicine Man/Medicine Woman: Roles in and pharmacists may earn continuing and H ea ling Traditions of rhe Ancient San H ealing; Shamanism and Pantheism in rhe education credit while attending these trips. Culture." We will be traveling to Botswana Sa n C ulture; T he Hor Zone: Prevention Everyone is welcome, so sign up now and and Namibia from August 2-14, 2003 and Treatment of Emerging Diseases; and remember to ask for your ABC member exploring health, healing, and nature H ea lrhcare Delivery: Limited Resources. discount. Visit
www.herba lgram.org 2003 HerbaiGram 57 I 9 Winter in ABC's Case Mill Homestead Garden
ou can never be quite sure what to ABC staff obtained on a field trip to Yexpect from winter in a central Texas the McAshan Gardens at Festival garden. It might be cold and dreary, but you Hill in Round Top, Texas. Also, have as good a chance that it will be sunny ABC has partnered with the Austin and 75 degrees. ABC's gardens welcomed Community Gardens (ACG) to the new year with echinacea, roses, calen produce 100 flats of mixed herbs, dula, rosemary, lave nder, pansies, jasmine, both culinary and medicinal, for and violas all blooming. Even a few pepper one of the biggest spring herb and plants still had peppers hanging on them. vegetable plant sales in Austin. The grass was green and the winter vegeta ACG lost their greenhouse in 2002 bles in the Antioxidant Garden enjoy the to disrepair and lack of funding, so rain and cooler weather. Despite the current combining resources to grow stock good weather, gardening in the winter here for the sale is a good community Volunteers from Austin's Com munity Gard ens, Elaine Dill and is about cleaning up and preparing for the outreach effort. ABC is supplying Randy Thompson, tend to mo re than 2,000 seed lings in ABC's spring, turning leaves into compost, and the greenhouse, seeding fl ats , and greenhouse, helping them to grow for springtime plant sales. covering tender plants when it does freeze. seeds donated by Horizon Seeds of This winter ABC garden staff and volun Williams, Oregon, and ACG is teers are spending quite a bit of their time in supplying seeds, planting medium, and enough plants to participate in two other the greenhouse, starting seeds and cuttings. volunteers to help grow and transplant the plant sales and host one onsite at ABC's One project involves propagating cuttings plants. In addition to the plant sale at the Case Mill H omes tead. --"' from many species of medicinal plants that ACG Sunshine Garden, ABC is growing -Gayle Engels
Membership Campaign Launches New Benefits and Services
embership contributions all ow ABC ways. One of the most exciting new benefits ethnobotanical tours offered through M to achieve its mission to provide is online access to H erbMedPro ™, an Health Quest Travel. This new benefit gives education using science-based and tradi interactive resource that provides hyperlink members a trip discount equal to their tional information to promote the responsi access to categorized scientific data underl y membership dues up to $ 150. More infor ble use of herbal medicine. In addition to a ing the use of herbs for health. T hrough a m ation on these discounts and the different major source of funding for the resources cooperati ve arrangement with the Alterna trips offered by H ealth Quest Travel is avail ABC produces, membership is a way for tive Medicine Foundation, it is now avail able on page 9 or by contacting Stacy Elliott ABC to get info rmation out to large able to ABC members at the Academic level at or 800/373- numbers of people and for them to partici and above. HerbMedPro TM enables simple 7105 ext. 101. pate in a meaningful way with ABC. keyword searches which may include herb New services have been added to the Membership benefits and services have names, particular chemicals or other ABC website to faci litate communication been expanded recently in a number of substances, health issues, research journals, between ABC and members, and make it authors, or specifi c articles. This unique easier for members to access online infor database permits use rs to navigate through mation. The updated website now all ows herbal resources found in PubMed, among new members to access members-only others, and provides additional information sections immediately upon enrollment. and searching capabilities. Members may now also renew, update their Members who join or renew at the Acad contact information, and change their user emic, Professional, and Organization levels name and password online. now receive a free copy of Herbal Medicine: More information on ABC member Expanded Commission E Monographs on ship levels and detail ed lists of benefits are CD-ROM. T his complete electronic printed on page 2 or contact Kim West at version of the book allows quick nav igation
10 I HerbaiGram 57 2003 www.herba lgram.org Herb Day USA: A Good Day for Herbal Medicine by Aviva Romm beauty, and health-giving properties every day. Proceeds from the events will be divided among the six organiza tions, which educate ix of the leading organizations in the botanical medicine indus the public and industry on herbal product safety and quality, tradi Stry and community - American Herbal Products Association tional and clinical herbal medicine practice, and botanical medicine (AHPA), American Herbal Pharmacopoeia (AHP), American conservation. Herbalists Guild, United Plant Savers, Most events wi ll be free, and will American Botanical Council, and include lectures and book signings by Herb Research Foundation - have nationall y acclaimed herbali sts and joined together under the name Herb authors, guided plant walks, product Day Coalition, in a proactive effort to '&:Herb Day USA demonstrations, crafts, kids acti vities, bring the good news about herbs to and product sample giveaways. H erb American consumers. Day USA has been described by many Long overdue, this cooperative effort, the inspiration of Michael in the herbal community as a "win-win" effort - everyone stands McGuffin, AHPA president, and Roy Upton, AHP executive direc to gain from the positive fo cus on herbs. tor, grew out of a des ire to prese nt consumers with accurate, In addition to the in-store events planned nationwide, a kick-off contemporary, and useful information about the beneficial role of event is being planned for earl y September to be held at the herbs in modern health care. National Botanical Gardens in Washington, D.C. The timing will In September 2003, a nationally coordinated day of herbal events coincide with Natural Products Expo East, a major natural prod will occur simultaneously in natural foods stores and botanical ucts and dietary supplement trade show, and will bring manufac gardens from coast-to-coast. With underwriting support from the turers, legislators , and consumers together for an afternoon of herbal manufacturing industry and retail ers (who are generously events, including.fresentations by noted guest speakers and special supporting the effort with national "5 percent days") these events entertamment. A will teach consumers about the medicinal and health benefits of herbs from many perspectives. In addition, there will be an atmos Aviva Romm is the National Coordinator ofH erb Day USA and Pres phere of celebration for the plants that provide us with fl avor, ident oft he American Herbalists Guild.
American Herbal Pharmacopoeia Publishes Angelica sinensis Monograph
he American Herbal Pharmacopoeia (AHP) has released its ities of dang gui. T his monograph provides the infor mati on neces Tquality control standards and therapeutic compendium for the sary for sourcing high quality material. popular botanical dietary supplement dong quai, or, as it is known This monograph is the 17th in an expanding se ri es produced by in Pinyin , dang gui (Angelica sinensis (Oliv.) Diels, Apiaceae). Each AHP. Each monograph provides a thorough critical review of all monograph se ts national standards to assure authenticity, purity, aspects of the plant and reliable information regarding the thera and quality control. T he Therapeutic Compendium sectio n peutic potential and safety of the herb to guide educated decisions provides a complete and critical review of the current pharmaco about its use. T he dang gui monograph is available for $ 19.95 (plus logical and safety data. shipping and handling) through AHP. The entire series is also avai l Dang gui is one of the most popular able for purchase individually or as a set from the American Botan Chinese herbal medicines, known for its ical Council (ABC's H erbal Education Catalog is at the back of this use in the treatment of a wide variety of iss ue and online at
by Nicholas H. Oberlies, Ph.D., Jennifer A. Greer, and recent advances in cancer treat Mansukh C. Wani, Ph .D. ment," said Oberlies. "The marker also honors a n Aug. 21, 2002, in the state of Wash tree," said Beutler, "and not just O ington, a historica l marker was a tree, but the idea that preserv unveiled ro commemorate the collection of ing biodiversity can have the original samples of Pacific yew ( Taxus important practical results. The brevifolia Nun., Taxaceae), which led ro the collection of Pacific yew bark eventual discovery of the anti-cancer was just the first step in a long compound Taxol® by Mansukh Wani, process that had a major impact Ph.D., and the late Monroe Wall, Ph .D., at on cancer therapy." Research Triangle Institute (RTI). At the annual ASP meeting The marker, consisting of a brass plaque held in Seattle in 2000, five affixed to a two-ron stone, is located in La members of the committee Wis Wis Campground in the Gifford scouted out the original coll ec Pinchot National Forest near Packwood, tion site. When they found approximately seven miles from the site what they believed to be it, they discovered RTI's Wall and Wani Fellowships where the first specimen was coll ected 40 it was not ideal for the marker. Oberlies To further honor the work of Drs. Wall years ago by a team of botanists led by explained, "It was on the side of Highway and Wani, RTI has started a prestigious Arthur Barclay, Ph.D., of the U.S. Depart 52 that is closed in the winter due to snow program of post-graduate fellowships in ment of Agriculture. cover and has few specimens of Pacific yew natural products research . The ultimate goal nearby. We wanted is to fund the work of three fellows via an the marker ro be close endowment that will pay for all of their ro a specimen." With compensation and benefits, ensuring that the assistance of the resources are going directly toward the U.S. Forest Service effort needed at the research bench to find (USFS), the commit new generations of compounds to treat tee identified a suit cancer. For more information or to make a able spot at the camp donation to the endowment, visit ground site, 20 feet
12 I HerbaiGram 57 2003 www.herbalgram .org USP Establishes Botanical Advisory Panel
he United States Pharmacopeia (USP) has created a new panel Tof leading experrs in herbal medicine, including the marketing, trade, cultivation, sourcing, and process ing of herbal products. "With the formation of the advisory panel, we will be able to obtain and disseminate information on how to improve the quality of botanicals, " sa id David B. Roll , director of dietary supplemems at US P. "Historically, USP has created standards for botanical products, however, we have never looked at factors rhar favor opti mal growth, handling, and storage of botanicals." T he new USP Botanical Advisory Panel wi ll provide information to the Dietary Supplements - Botanicals Expert Committee, a standing USP committee chaired by Paul Schiff, Ph.D., of the University of Pittsburgh Coll ege of Pharmacy, which develops monographs and es tablishes standards for botanical dietary supple ments. T he new panel will develop informati on on: The USP Botanical Advisory Panel held its first meeting in November 2002 at Historical uses USP headquarters in Rockville, Maryland. Seated (left to right) are Roy Upton, Commercial growing sources Simon Mills, William Popin, Mark Blumenthal, and Jennifer Montgomery Salguero, USP staff scientist. Standing are John Cardell ina, James Miller, Gabriel Good agricultural practices, including collection and harvest Giancaspro, Greg Pennyroyal, Ed Fletcher, Vice President of USP's Dietary Supple ing (co nservati on status, optimal rimes of harvest, optimal ment Verification Program Srini Srinivasan, USP staff scientist Maged Shara( Paul handling process, optimal coll ection practices), plus informa Schiff, and David Roll tion on cultivation, including packaging practices; handling and processing; drying and storage conditions; adulterants The panel agreed to focus on Boran ical idem ific arion the most imporram botanicals in • C hemical constituents the market, including, but not Table I Species of • The feasibility of developing Authentic Plant Reference Mate li mited to, the 25 botanicals for USP Botanical ri als that would be used by regulatory agencies within and which USP has already developed Monographs Published outside the United States monographs (from 1995 to 2002 1995-2002 • Regulatory status in other countries USP has published 86 standards T he panel also plans to create additional in formation chapters for monographs on 25 herbs). These Black cohosh a future edition of the United States Pharmacopeia and National 25 herbs were prev iously picked Chamomile Formulary (USP-NF). by US P because of their relative Chaste tree popularity in rhe U.S. marker (See C ranberry Table I). The first four botanicals USP Botanical Advisory Board Members Echinacea angustifolia to be examined are gin ger, va ler Echinacea pal/ida he new 12-member Botanical Advisory Panel includes representatives ian, saw palmetto, and bl ack Echinacea purpurea root Tfrom academia, government, and industry. The panel is chaired by cohosh. Eleuthero William F. Popin, the director of research and development and quality USP Standards monographs for for Young Living Essential Oils, of Payson, Utah. He also is a member of Feverfew botanicals and other dietary USP's Dietary Supplement- Botanicals Experr Committee. Garlic supplements are recognized by the Orher members of rhe panel are: Ginger Simon Mills, M.A., FNIMH, NCPP, director of rhe Centre for U.S. Food and Drug Administra Ginkgo Complementary Healrh Studies, at rhe University of Exeter, Devon, tion (FDA) as the official standard England; Rudolf Bauer, Ph.D., professor at rhe Institut fur Phar for a substance and can be the Ginseng, American makognosie, Graz, Austria; Mark Blumenthal, founder and executive basis for enforcemem policy and Ginseng, Asian director of rhe American Botanical Council; Amala Raman, senior acti ons by FDA. Goldenseal postgraduate tutor, King's College, London, England; Roy Upton, In general , the new Botanical Hawthorn leaf with executive director of rhe American Herbal Pharmacopoeia, Scotts Advisory Panel will focus o n flower Valley, California; John Cardellina, Ph.D., vice president of rhe Coun information about specifi c herbs Horse Chestnut cil for Responsible Nutrition, Washington D.C.; James Miller, Ph.D., that are not intended to be incor curator and head of rhe Applied Research Department, Missouri Botan Kava porated into the monographs. ical Garden; Greg Pennyroyal, president of Growing Medicine Inc., licorice Signal Hill, California; Ezio Bomabardelli, Ph.D., of Indena S.pA, The USP was es tabli shed in Milk Thistle 1820 and is recognized as the offi Milan, Italy; Kathy Sharpless, Ph.D., research chemist wirh the Myrrh cial U .S . organization empowered Analytical Chemistry Division at rhe National Institute of Standards Nettles and Technology, Gaithersburg, Maryland; Edward Fletcher, Ph.D., to es tablish standards for pharma Red C lover Strategic Sourcing Inc. of Banner Elk, Norrh Carolina; Gabriel Gian ceuticals, healthcare technologies, caspro, Ph.D., USP senior scientist, is the USP staff liaison to rhe and di etary supplemems. A Saw Palmetto panel. -Mark Blumenthal Valerian www.herbalgram.org 2003 HerbaiGram 57 I 13 Native American Botanies Garners NCCAM Research Award
ative Ameri can Botanies Corporati on was awarded a $667,000 studies with whole herbs, rather than being res tricted to standard NPhase II Small Business Innovation Research grant from the ized extracts only. National Center for C omplementary and Alternative Medicine to T he grant, awarded over a three-year period, is a Phase II research explore a new cultivation method for medicinal root crops.1 award available to small businesses. Eligible small businesses must G rant collaborators include researchers from the University of first compete nationally for Phase I awards, complete feasibili ty Arizona, North Carolina State Uni ve rsity, New Mexico State research, then compete agai n for Phase II funding. :__.. U ni ve rsity, Nati ve Seed/SEARC H , and N utritional Laboratories [I. at ive Ameri ca n Botanies Corporation . National Institutes of Hea lth International who will investigate echinacea (Echinacea p urp urea announces $667,000 research award to Native America n Botan ies (L.) Moench, As teraceae), black cohosh (Actaea racemosa L, Ranun [press re lease] . September 24, 2002. 2. Hayden AL, Giacomelli GA, Yokelson T, Hoffmann Aeroponics: culaceae, syn. Cimicifuga racemosa (L.) N utt), stinging nettle JJ. An Altern ati ve Production System for High-Value Roo t Crops. Acta (Urtica dioica L. , ss p. dioica, Urticaceae), and yerba mansa Horticufturae. 2003 (in press). Proceedings, XXVIth International (Anemopsis californica (Nun.) H ook. & Am ., Saururaceae). Horticul tural Congress, Future fo r Medicinal and Aromatic Pl ants, "The research we'll be doing will provide a sustainable produc Toro nto, Ontario , Canada. August, 2002 .] ti on alrernative to the current practi ce of over-harves ting threatened species of herbs from wild populations," said Principal Investigator and C hief Development O ffi cer Anita "Teena" H ayden, Ph.D . The Bastyr University Helps Define company, located on the Pascua Yaqui Reservati on near Tucson, Naturopathic Research Agenda also markets a line of herbal supplements incl uding echinacea and black co hosh. astyr University is convening a seri es of meetings to help H ayden's preliminary research 2 has demonstrated higher consis Bdevelop a prioritized agenda for naturopathic research tency in the quality of root materi al harvested from the aeroponic conducted in North Ameri ca. growing system - a modified hydroponi c sys tem in which roots "In recent years, a growing number of people have found that hang in a chamber where they are sprayed from below with a nutri naturopathic medicine has improved the quali ty of their life," said ent solu tio n - which will permit future researchers to do clinical Leanna Standish, N.D ., Ph.D ., L.Ac., se nior research scientist at Bastyr Uni versity and principal inves tigator on the grant. "This has given ri se to the increased need for solid, scientific research to back up the hypothes is that naturopathic medicine is effective." T he effort is funded by a rwo-year $250,000 grant entitled "North American Medical Research Agenda" from the Nati onal Columbia University Center for Complementary and Alternative Medicine of the Co Uege of Phys icia ns & Surgeons National Institutes of H ealth. In earl y February 2003, Bastyr Uni versity brought together naturopathic phys icians from the four CME Courses 2003 other naturo pathic medical schools in North America: Southwes t Sponso red by College of Naruropathic Medicine and Health Sciences of Tempe, Department of Rehabi li ta ti on Medicin e Ari zona; U niversity of Bridgeport College of Naturopathic Medicine The Richard and Hinda Rosenthal Center for Co mplementary & of Bridgeport, Connecti cut; National College of N aturopathic Alternative Med ici ne Medicine of Portland, Oregon; and the Canadian College ofNatur opathic Medicine of North Yo rk, O ntario, Canada. May 16-1 7, 2003- New Yo rk City Experts from the University of Washington, Duke University, "INTEGRATIVE PAIN MEDICINE" University of California at Los Angeles, Stanford University, and the Kaiser Center for H ealth Research also attended, representing Course Co-Directors: James N. D illard, M.D. conve ntional medical research. and Fredi Kronenberg, Ph.D. A working group of 20 will mee t during the nex t rwo years to identi fY what kind of research will address fundamental healrh June 9-1 3, 2003- New Yo rk City issues for the American public and appropriate research des ign "BOTANICAL MEDICINE IN MODERN methods for each . T he February meeting at Bas tyr University included presenta CLINICAL PRACTICE" tions by several naruropathic phys icians on topics ranging from Course Co-Directo rs: Fredi Kro nenberg, Ph.D. scientific investigation to emerging research in mind/body medi cine. La ter meetings will gather comments from scientists, and Andrew Wei!, M.D. researchers, and other members of the co mmunity. T he research FOR MORE INFORMATION & AN APPLICATION panel will p ro duce a final document, T he North American Medical Research Agenda. -" CME Dept.: (2 12) 305-3334 -- http://ColumbiaCME.org -Karen Robin http:/ /www.rosen thal.hs.colum bia.ed u [So urce: Bastyr Unive rsity. Bastyr Unive rsity hosts national group on natu ro pathi c medi cine resea rch [press release]. 2003 February 4.]
14 I HerbaiGram 57 2003 www. herbalgram.org Nutritional Outlook Names 2002 Manufacturers of the Year
utritional Outlook srruck a theme of high qualiry as it honored GMP certification from the National Nutritional Foods Associa Nrwo companies in irs November/December 2002 issue as manu tion, whi ch appears on the labels of its products. facturers of the year: Nature's Sunshine Products, of Provo, Utah, A famil y-owned company, the magazine reports that the owners and Country Life, of Hauppauge, New York. Both compani es have "beli eve in qualiry and incorporate their belief into every parr of the inves ted heavily in their facilities, despite a difficult marker. busin ess ." Nature's Sunshine recently completed a fi ve-year $2 1-million Nature's Sunshine celebrated irs 30th anniversa ry in 2002; Coun expansion of irs manufacturing and distribution faciliry in compli try Life celebrates the same milestone of 30 years during 2003. T he ance with good manufacturing practices (GMPs) to produce thou new fac ilities are described in derail in the Nutritional Outlook ani sands of herb, vitamin and other nonherbal products. de, which is available online
utrition Business journal launched its Business Ac hi evement dispenses vitamins, herbs and advice, is recognized as one of the premier NAwards in its D ecember iss ue, naming a number of compani es all-natural pharmacies. Four rimes from 1996-2000 Wagner was rhe phar and individuals for their achievement in th e nutnnon industry. macist on the World Health M iss ion to N igeria, accompanying a group of "While 2002 won't be remembered as the best year ever in the physicians to delive r med ical supplies, volunreer in hospitals, and educate industry, there were ample companies and products that merit pharmacy and medical srudenrs. As parr of the Student Rainfores t Fund, recognition," the magazine writes . Wagner regularly leads groups of srudents to Central America to wo rk with Winners were selected in the following categori es : G rowth in indige nous healers and discover the roots of herbal medicine. He is a Large and Mid-Size Compani es, Investment in a Tough Climate, member of the ABC Advisory Board. Management, Efforrs on Behalf of the Industry, Environment & Product Merit Awards Sustainabili ry, Personal Service, and Product Merit. While several non-herbal companies are named in the arricle, here we li st th ose • NSF lnrernational for developing an accredited, co nse nsus-based that are botanically oriented. The full list may be found online at certification standard for the dietary supplement industry (American www. herbalgram .org 2003 HerbaiGram 57 I 15 NFAM Honors Founder Bedell, Others with CAM Leadership Awards he Nati onal Foundation for Alternative Medical Treatmem Act. care, is rhe nati on's leading expen on the T Medicine (NFAM) honored its founder In addition to honoring Mr. Bedell, operational and ethical problems of Ameri and chairman, Berkley Bedel l, as well as N FAM besrowed special leadership awards can corporate healthcare. others who have co ntributed ro rh e fi eld, at upon 12 distinguished CAM leaders: Candace Pert, Ph.D., and Michael a black-rie dinner in Washingron , D.C., on Candace Campbell, Executive Direcror Ruff, Ph.D., groundbreaking neuroscien November 16, 2002. of the Ameri can Associati on for H ealrh ti st and research professor, Dr. Pen is cred NFAM is an information resource for Freedom, has lobbi ed intensively for the ited with the discovery of the opiate recep ca ncer patients and for those who suffe r passage of the Access to Medical Treatment tor and is the author of the bes t-selling fro m other degenerative diseases. N FAM Act, the foremost poli tical vo ice protecting book, Molecules of Emotion: Why You Feel provid es alternative medicine info rmati on the rights of CAM practitioners. the ~y You Feel. She and Dr. Ruff, her and resources ro people free of charge. T he Larry Dossey, M.D., Executive Editor of research partner and husband, are pioneers miss ion of NFAM is to seek our effecrive A lternative Therapies in Health & Medicine, in rhe field of emotions and healing and rhe complementary and alternative medicine al so authored nine books on rhe merging of interconnectedness of the brain and the (CAM) treatments currently inaccess ible or spirituality and medicin e. Although deeply nervous, endocrine, and immune sys tems. unava il able in the United States, evaluate rooted in the scientific world, he has T hey are se ni or researchers at the George rhe prorocols and outco mes of these treat become an imernati onall y influential advo town Unive rsity School of Medicine. ments, and report their findings to rh e cate of the ro le of the mind in health and Joseph Pizzorno, Jr., N.D., Pres idenr general public. the role of spirituali ty in healthcare. Emeri tus of Bastyr University, an institution NFAM also announced strategic alliances Wayne Jonas, M.D., Direcror of the he co-founded in 1978, authored rhree with rhe Cancer Treatment Research Foun O ffi ce of Al ternative Medicine (now rhe books on the healing traditions of natural dation and rhe Samueli Institute. T hese NCCAM) from 1995-98, created 13 major medicine and is a phys ician, researcher, associations will benefit rhe foundatio n In research ce nrers and managed more than 50 lecturer, journal edi tor and educator with the conducting of internati onal phase II research projects, helping to se t the national over 25 years of experi ence in the fi eld of clinica l tri als, including ongoing trials 111 agenda for CAM in the 21st cenrury. He is natural health. Germ any and Italy and projected trials 111 currently the Director of the Samueli Insti Bernie Siegel, M.D., internationall y Canada and South America. tute, an international research organization known inspirational speaker and former "T hese research collaborati ons will hel p reviewing the biology of healing and its rela surgeon, is the author of eight books, rhose in the CAM field work rogether ro tionship to health and disease. including Love, Medicine & Miracles. In provide clear and concise answers ro li fe and Diane Ladd, ac tress, director, producer, 1978 he starred Exceptio nal Cancer death ques ti ons in a world in whi ch there is three-rime Academy Award nominee and Pati ents, an organization rhar focuses on rhe righr now a good deal of chaos about just winner of the British Academy Award, is a healing potenrial prese nt in every patienr. what CAM means," Mr. Bedell said . passionate advoca te who has tes ti fie d before Dr. Siegel is involve d in humanizi ng NFAM will also partner wirh Conscious Congress on CAM iss ues. She is a ce rtified medical education and in making the Media and W isdom Television and Radio nutritional counselor and has authored a medical profess ion aware of rhe mind-body Network ro advance irs educational initia nutritional health book, Spiraling Through connection in healing. tives in Ameri ca and ove rseas. NFAM will the School of Life. Susan Silberstein, Ph.D., Founder and soon open a London satellite offi ce. Ralph Moss, Ph.D., an internationally Executive Director of the Center for While the primary foc us of NFAM has respected science writer and patienr advo Advancemenr in Cancer Education, es tab been on cancer, the foundati on has begun cate, has spent more than 20 years trave ling li shed rhis non-profit patient adviso ry and initial sire vis its to clinics that treat other the world in search of valid alternative referral se rvice in 1977, foll owing her degenerative diseases . NFAM is rh e only cance r trearmenrs. He is the author of 11 young husband's death from cancer. She enrity in rhe United Stares rhar actively books and 3 documenraries on cance r (a nd rhe staff of volunteers she trained) have reviews inrernari onal clinics treating degen related ropi cs and publishes "T he Moss counseled over 20,000 patients in the past erative diseases. In addition ro this unique Reports" for ca nce r pati ents. 25 years wirhour ever charging a fee. investigati ve ro le, NFAM makes rhe res ults James Oschman, Ph.D., inrernarional Demetrio Sodi-Pallares, M.D., an inrer from these in ves tigations ava il able ro rh e authority and author of two books on nari o nally recognized cardiologist, is a public. energy medicine, a former academic cell cancer researcher and author of 1G books In his poli tical life, Mr. Bedell is most bi ologist, has publis hed more than GO and 300 scientific papers and has bee n noted fo r having served six-terms as a research articles. His goal is to bridge the awa rd ed over 100 honorary degrees. He Democratic U.S. Congress man from Iowa, intellectual barriers between different ac hi eved international fam e by demonstrat working wi th Sen. Tom H arkin to es tablish approaches ro clinical medicine so rhar new ing dramatic res ults treating cardiovascul ar the Office of Al ternati ve Medicine (now discoveries ca n be made to enhance patient diseases and advanced cancers, and known as rh e National Cenrer fo r Comple care. currently co ll aborates with approximately mentary and Alternative Medicine, Linda Peeno, M.D., a fo rmer H M O .100 ~h ys i c i a n s in Central and South Amer NCCAM) at the National Insrirures of medical rev iewer and hos pital ethics Ica. A H eal th, and with Sen. Tom Daschle to ass ist committee chair who became a moral in writing and advocating for the Access to crusader against the abuses of managed [So urce: NFAM press releases onlin e 16 I Herba\Gram 57 2003 www.herbalgram.org Rainforest Maps Help Protect Indian lands he Amazon Conservation Team (ACT) is helping South Amer --+-.;.._ · ~-· ---h---1------:-----i--- T ica Indians w map, manage, and protect their ancestral lands. i .._""" deTrio·s ;n -..... Suriname ~ HarloiiCJI'*WI_ ,..._....,.._ s.n- ~ The maps of sections of southern Suriname and adj acent Brazil i t..IU.. of ... TI'IO ,...... In _..._ record for the first rime the names of vill ages, rivers, mountains, I ~ \ r \ . --- and sacred places utilized and honored by four tribes - the Tiri6, - - Kaxuyana, Wayana, and Apalai - who li ve in the remote rain forests of the northeast Amazon. =- T he maps - actually made by the Indians themselves - docu ment 20 million acres of tropical forest and should help protect these lands from outsiders hoping w exploit the resources. Further more, these regions also include the headwaters of several major ri vers; protecting them will ensure water quali ty for rhe peoples who live downstream as well. T he Indians are already using the maps as incipient manage ment plans w better utilize local resources, such as Brazil nuts...... ,.. . . / /..=) ) ~ ; · I ' ' J ' ,, Above: This map of 10 million acres in southern Suriname represents the ancest ral territory of the Tiri6 Tiri6 Indians of Brazil study the map made of adjacent Indian lands in Suriname. tribe. The Indians themselves made The Suriname map inspired the mapping project in Brazil. Photo by Vasco Van this map in close collaboration with Roosma len, Amazon Conservation Team. the Amazon Conservation Team and the government of Su riname. Right: Two Apa lai boys study the ACT was the main organizer of the project, and collaborated map of their ancestral lands. These cl osely with the governments of Brazi l and Suriname as well as the maps have proven to be excellent Indians themselves. T he main partner in Brazil was the Burea u of tools to teac h children about their Indian Affairs (FUNAI) while in Suriname it was the National history, their resources, and their Cartographic Agency (CBL), and the project was funded by the culture. Photo by Vasco Van Roos· malen, Amazon Conservation Team. Gordon and Berry Moore Foundation. A major goal of the effort was to meld ancient shamanic wisdom has also mapped regions in Columbia and more than a million ac res and knowledge of the landscape (everything from sacred sires to in Brazil's Xi ngu Indige nous Reserve. Another ACT initiative, the mythological creatures) to 21st century technology (e.g., satellite Shaman's Apprentice Program, brings tribes' yo ung people together phows, handheld global positioning systems). Indians covered with traditional shamans and other elders to become the healers every inch of their difficult, and biodiverse terri wries, coll ecting and environmental guardians of the future. ACT's programs are GPS data. Tribal elders provided names for features that had been derailed on irs website 18 J HerbaiGram 57 2003 www.herbalgram.org help establish a rational system to determine the safety of popular • CAM research challenges and needs; supplement ingredients. • CAM regulation in the United States and other countries; The National Academies, the parent organization of the IOM, is • interface and integration of CAM with conventional medicine; a private, nonprofit, non-governmental institution created by • training and certification questions. congressional charter to be an advisory body for the nation on The committee will also develop conceptual frameworks to guide scientific and technological matters. The !OM draws upon vo lun decision-making on these iss ues and questions. It will not conduct teer panels of experts to examine policy matters regarding the new surveys of CAM use by the American public, nor will it assess public's health. the efficacy or safety of CAM products, but will gather and analyze existing data, which may complement the recommendations of the 10M to Study CAM White House Commission on Complementary and Alternative The National Center for Complementary and Alternative Medi Medicine Policy released last year. cine and 16 other federal co-sponsors recently launched a $1 More information, including the roster of panel members, is million, two-year !OM study of the scientific and policy implica avai lable online at European Union Passes Traditional Herbal Medicines Directive n November 21, 2002, the European Parliament approved the [Source: Fischer-Mertens G . Europe OKs Traditional Herbal Medicines O Directive on Traditional Herbal Medicines (THMs), estab Directive. OTC NewsAash, Nicholas Hall, 2002 Nov 22.] lishing basic quality and safety standards for herbal remedies across Europe. The new regulatory system establishes a new registration system for THMs, and a criterion to prove safety through "tradi tional use": they must have been sold on the market for at least 30 HERBAL SCIENCES PROGRAM years, with at least 15 years' use in Europe. A new labeling system is also being developed; currenrly unlicensed remedies cannot make claims for their intended use or the conditions they can treat or cure. A new Committee on Herbal Medicinal Products is being established to evaluate herbal medicine products. The Parliament also approved the provision of a statement to accompany product information describing "in an appropriate way" the product's nature and main priorities, and possible adve rse reactions and/or interactions with food or other drugs. In addition, an herbal medicines classification system will take into account composition and pharmacological/ toxicological effects, and declare therapeutic indications, routes of administration, daily dose ranges, and other related information to promote safe use. According to a news brief from OTC Newsjlash, an electronic newsletter from the European pharmaceutical consulting group Nicholas Hall, "Varied reactions to the Directive's approval reflect GET AHIGHER EDUCATION IN EVERY SENSE wide discrepancies in herbals usage across the region. While Germany, for example, has a huge range of traditional herbal medi cines (many prescribed by doctors), UK consumers view 'herbals' as Bastyr is proud to be the country's first accredited dietary supplements and view the Directive as imposing strict new institution to offer an herbal sciences program. Explore rules on their use. However, few can doubt the need for [increased] medicinal herbs. Get to the root of herbal quality legislation." A report on the European regulatory system as well as global issues. And be prepared for a growing career in your regulatory and market conditions, Herbal, Complementary & Alter choice of fields. native Medicines: Connecting to New Realities by G ilbert Fischer Mertens, was published by Nicholas Hall at the end 2002. For BASTYR more information, contact evi ewed: Glazier M G, Bowman MA. phytoes rrogen consumption, but they than others. Some large and many smal l RReview of the evidence for the use of acknowledge that the evidence on the bene studies show mos tly positive results in link phytoestrogens as a replacement for tradi fits of phytoestrogens is increas ing. ing soy isoAavones with a reduction in tional es trogen replacement therapy. T he authors found evidence in the litera serum lipids in persons with hypercholes Archives of Internal Medicine 200 I May ture that phytoestrogens have several poten terolemia. Despite the diffi cul ty in synthe 14; 161:1161 -72. tial anticarcinoge nic properties against sizing data from numerous and vari ed stud Menopausa l hormone therapy, also horm one-dependent and other cancers. ies, current research results poin t to phytoe known as hormone replacement therapy Genistein appears to be the primary ami srrogen hav ing a beneficial effect on lipid (HRT), has been used for more than 40 cancer constituent of soy {Glycine max (L.) values, and no studies have shown elevation years to reduce osteoporosis ri sk and Merr., Fabaceae), ex hibiting antioxidant of lipid va lues due to phytoes trogen intake. menopausal sy mptoms in menopausal properties and suppression of enzymes that Most women start HRT to reduce hot wo men. An increased interes t by consumers promote cell growth. T he authors state that Aas hes. Few co ntrolled studies have exam in natural products to replace HRT led the no recommendati ons can be made concern ined the effec t of phytoesrrogens on authors to review the current literature on ing phytoestroge n use in cancer prevemion menopausal symptoms, and those that plant-derived compounds with es trogenic and treatment except that there have been show stati stically significant res ults are of acti vity, also known as phytoes trogens. encouraging effects in vitro. ques ti onable cl inical significance. [T his review was conducted prior to the HRT is linked to the devel opment of T he authors caution that, while evidence announcement by the U. S. National in favo r of phyroes trogens increases, Institutes of H ealth in July 2001 that important issues need resolution. HRT increases the risk of breast Potential theoreti cal adverse effects cance r and cardiovascul ar disease, include inducing breast cancer in res ulting in rhe termination of at low-estrogen enviro nments. least rwo long- term HRT studies.] Current evidence is roo sparse to Phytoes trogens are plant develop dosage recommendatio ns or compounds that show weak estro formulations of phyroestrogens. ge nic activity. Of the four main types Many ques ti ons surro und their use, of phytoestrogens {isoAavones, and the authors suggest prospective coumes tans, li gnans, and resorcyclic randomized controll ed trials to acid lactones), the isoAavones, in observe the effects and safety of particular genistein and daidzein varying formulations and dosages of from soy and other legumes, are the phytoestrogens on va ri ous tiss ues. most important in terms of their T he authors conclude that level of activi ty and abundance in the Soy Glycine max. Photo © 2003 stevenfoster.com recommending replacement of diet, and amount of research H RT with phyroestrogen use is performed . This article summarizes breast cancer. Observational studies of premature and not supported by current published experimental data about poss ible countries in which dietary phytoestrogen research. Despite these cautions, no defin i benefits and ri sks associated with use of intake is hi gh have very low incidences of tive evidence shows that consumption of phytoestrogens, and compares these to the breast cance r. However, animal and in vitro phyroesrrogens in normal dietary amounts known benefits and ri sks of prescribed studies cited in this article suggest rhar is harmful. T he authors encourage a HRT. ge nistein could actually be a tumor promo prudent diet high in plant foods and low in T he authors culled 74 studies from more tor, depending on its concentrati on in the meat and sa turated fa t, whi ch would res ult than I ,000 published articles on phytoe cell. In addition, the authors postulate that, in increased overall phyroes trogen intake srroge ns published from January I, 1966, with the evidence rhey found in the li tera and is consistent with current dietary through September 30, 1999. The studies ture, phytoesrroge ns may protect against recommendations. were selected based on English language, breast cancer before menopause, bur may W hil e this well -researched and thorough rel eva nce, use of human subjects wherever stimulate development of breast cancer in article furthers understanding of ava il able possible, and stro ng study des ign, with the low-estrogen environment of data through 1999, recent heightened inter preference given to randomized, blinded, menopause. es t in phyroesrrogen use in disease preven controlled studies over observati onal or HRT has been shown to lower total tion, together with defini tive proof that epidemiological studies. Most of the infor se rum cholesterol and increase the high HRT is inappropriate for disease prevention mati on on phytoesrroge ns comes from in density lipoprotein choles terol (the "good" because it does more harm than good in vitro or animal studies, with little ri gorous choles terol) level. Phytoestrogens, es pecially healthy women, should encourage more up clinical research on humans. The available those from soy, have been inves tiga ted as to-date information on phyroes troge n epidemiological and observational studies possible lipid-lowering agem s due to use. -" are subject to a host of confounding factors. epidemiological evidence that the incidence -Diane 5. Graves, M.P.H., R.D. The authors consider data supporting HRT of cardiovascular disease in co untries where to be much more convincing than that for large amounts of soy are consumed is lower 20 I HerbaiGram 57 2003 www.herbalgram.org Blood Coagulation, Surgery, and the Use of Herbal Medicine eviewed: Shaw HS, Kroll D. The However, many surgical procedures are note. Rconvergence of herb pharmacodynam done on an emergency basis. [Further, the Genetic diversity may explain some ics and herb-drug interactions on hemosta line between many herbs and common conflicting data on the safety of specific sis. Alternative Therapies 200 I foods is arbitrary. For example, tomatoes herbs or alternative treatments. A small Nov/Dec;7(6):46-7. and potatoes affect recovery from anesthe percentage of individuals may be genetically Blood coagulation is a complex process in sia, prolonging its effect.] Therefore, clini predisposed to adverse effects. These are which cascades of clotting factors work cians, particularly surgeons and anesthesiol among the important considerations of a together to limit blood loss at the site of ogists/nurse anesthetists, should be well relatively new scientific field cal led "phar injury while maintaining blood flow informed about the potential effects of macogenomics." throughout the rest of the body. Hemostasis herbs and overall diet on bleeding and coag Finally, the risk of an adverse reaction is refers to the stoppage of bleeding by the ulation. In addition, clinicians should ask generally higher when two or more drugs, body's coagulation process or by mechanical patients about their use of herbal remedies herbs, or herb/drug combinations are used or chemical means. "Disorders of hemosta in a nonjudgmental way. Open discussions together. Drug safety testing cannot possi sis can range from coagulopathies or over between patients and clinicians about medi bly evaluate all the potenrial combinations coagulation, which can lead to problems cine use - including both pharmaceutical, and inreractions, which typically come to such as deep-vein thrombosis or stroke, to over-the-counter, and herbal medicines - light after the drug has been approved. "An bleeding diatheses [constitutional predispo may reduce the probability of compli ca herbal extract may positively or negatively sitions] and under-coagulation, which can tions and adverse reactions. affect the metabolism of other agenrs by lead to life-threatening hemorrhage," write Another issue raised in this article is the decreas ing the effectiveness or enhancing the authors of this study. theory that adverse reactions are often the potenrial toxicity of a second drug," the Many herbs have potential effects upon unpredictable because the population is authors report. They call for research that the body's hemostatic process or upon the genetically diverse. "Any agent, natural or will build an extensive knowledge base of actions of anticoagulant drugs such as synthetic, possesses some degree of risk the influence of various herbs on drug warfarin (Coumadin®), aspmn, and associated with its benefits when it is used metabolism and hemostasis. Yet relying on heparin. Various natural and synthetic by hundreds of millions of genetically such research to predict adverse reactions is agents, including such common foods as diverse individuals. For example, recent still problematic, they note. In particular, green leafY vegetables, may also influence FDA withdrawals of prescription drugs anecdotal reports and case studies should the hemostatic process. reflect the unpredictable nature of adverse be viewed with much caution and are best To prevent bleeding complications reactions and even deaths," the authors used as signals that further research may be during and after surgery, the authors recom write. The strictest drug approval proce needed. ~ mend that patients stop all herbal medicines dures in the world rarely require safety data - Christina Chase, M.S., R.D. at least two weeks before planned surgery. from more than 5,000 human subjects, they Small Trial Fails to Show Benefits of Echinacea to Treat Genital Herpes eviewed: Vonau B, Chard S, Mandalia supporting the well-known immunostimu reduce the frequency and severity of genital RS, Wilkinson D, Barron SE. Does the lating effects of echinacea preparations. herpes recurrences. The product used (Echi extract of the planr Echinacea purpurea Several anti-viral drugs are considered naforce®, manufactured and supplied to the influence the clinical course of recurrenr safe and effective for limiting the symptoms researchers by Bioforce, Switzerland) is an genital herpes? InternationaL journaL ofSTD of genital herpes and reducing recurrences. ethanolic extract made up of 95 percent E. & AIDS 2001 ;12:154-8. However, some patients cannot take these purpurea aerial parts and 5 percenr E. Genital herpes is caused by herpes drugs due to side effects or drug allergies; purpurea root. Dosage was 800 mg, twice simplex virus type I or type 2. The infec others report breakthrough recurrences of daily. tion causes genital ulcerations that can recur herpes while on long-term therapy. For Twenty-five subjects received the placebo after the initial infection has healed because these reasons, and because some consumers and then echinacea (for 6 months each), the virus may remain latenr for a period of consider herbal medicine safer than phar while 25 other subjects received echinacea time and then reactivate. The reactivation maceutical drugs, the authors report, some first and placebo second. The mean subject triggers are not fully understood, but appear people use echinacea to prevent and treat age was 36.5 years (range: 22-72 yea rs), 24 to include other infections, localized genital herpes recurrences. However, no men and 26 women. Subjects reported that trauma, exposure to ultraviolet light, and placebo-controlled, randomized, prospec they had their first genital herpes infection psychological stress. tive studies have been published on the from 3 months to 20 years before the study Echinacea (Echinacea purpurea (L.) usefUlness of E. purpurea extract for genital began, and with a median of 7 recurrences Moench, Asteraceae) grows in North Amer herpes. per year. ica and was used by Native Americans for This prospective, double-blind crossover At study entry, all subjects completed a various medical problems, including mouth study attempted to evaluate whether treat physical examination, medical history, and ulcers. This study cites several studies ment with oral E. purpurea extract could psychological evaluation. During the study, www.herbalgram.org 2003 HerbaiGram 57 I 21 subjects were assessed monthly and also as limitations, the authors conclude that they addition, when the patients were asked soon as possible (within 72 hours) after found no significant benefit from the plant (while still blinded) on which medication onset of a new genital herpes recurrence. and root extract of echinacea for reduci ng they fared better, 12 favored echinacea Subjects were asked to record their symp rhe frequency of genital herpes recurrences. while only 5 favored placebo. Yet, the toms during recurrences, the occurrence of They then make this somewhat surprising authors confidently state that no further any other viral illnesses, their stress levels, statement, "Given that there are safe and studies are warranted!" and compli ance with study medication. For efficacious alternatives [i.e., pharmaceutical The reviewer concluded, ''I'm sure that each recurrence, subjects reported the dura drugs], the value of further studies into its no one who takes or prescribes it for herpes tion and rated their pain by using a visual benefits for this indication seem unjusti thinks echinacea will have a huge effect. analogue scale. fied." It is difficult ro understand how rhe Anyone interested in 'natural' health would Too few subjects completed the study to authors can dismiss future research in this be doing multiple things to reduce recur allow detection of significant differences at area when this srudy's conclusions are so rences. Thus, since rhe trial studied echi the level of statistical power selected (a tentative, especially considering the lack of nacea in isolation, it should be sensitive to a power of 80 percent, to detect a difference statistical power due to the high dropout small effect in order to answer the prag of 20 percent in reduction of recurrence rate. matic question, 'Would the addition of frequency). Of the 50 subjects, 19 (38 One of HerbalGram's reviewers added the echinacea to the management of herpes be percent) dropped our; at least 47 were following comment on this point, "In the beneficial?' T his trial wasn't sensitive to needed to complete rhe study to detect worst light, these researchers seem to have small effect (20 percent reduction of recur significant differences. The authors attrib performed a study incapable of detecting a rence)." -"" ute the drop-out rate to the requirement for statistically significant difference and -Christina Chase, M.S., R.D. frequent study visits and blood samples. discarded as an artifact a trend in favor of a After acknowledging some of their study's non-statistically significant difference. In Assessment of Herb-Drug Interactions in Literature Shows Many Case Reports Lack Adequate Information to Determine Reliability eviewed: Fugh-Berman A, Ernst E. while not val idated, helped to determine 108 cases of suspected interactions, which RHerb-drug interactions: Review and whether reports of herb-drug interactions were tabulated in the article and categorized assessment of report reliability. British jour contained reliable information. Reports by patient description, herb, drug, other nal of Clinical Pharmacology 2001 ;52:587- received one point for each of the following: medications, signs or symptoms of interac 95. • Adequate patient history tion, mechanism, and report reliability This article assesses the published clinical • Concurrent diseases, conditions, or score. Seventy-four cases (68.5 percent) literature regarding interactions between medications presumably are not associ were considered to contain insufficient conventional drugs and herbal medicinal ated with the adverse event [The orig information to evaluate (unevaluable), 14 products. While many, though not all, inal article contained a misprint stating ( 13 percent) were classified as well-docu drug-drug interactions are well defined, the that " ... medications associated with an mented (likely), and 20 (18.5 percent) as authors state that herb-drug interactions adverse event"] possible. may occur more frequently due to the many Documentation of concomitant The authors review published herb-drug pharmacologically active compounds pres medications interactions. From these clinical studies and ent in most herbal products. • Adequate description of interactors the case reports, they surmise that enough A search of Medline, Embase, the • Exclusion of obvious alternati ve expla cases of interactions with SSRis have been Cochrane Library, and CISCOM (a data nations reported that a serotonin-amplifYing effect base specializing in alternative medicine • Complete chronology of St. John's wort (Hypericum perforatum L., literature) from their inception to 2000 was • Reasonable time sequence of drug Clusiaceae) could occur. Patients taking St. conducted using the search terms "herbal administration to adverse event John's wort or anticoagulants are at the medicine," "botanical medicine," • Adequate description of adverse event highest risk of an herb-drug interaction. "phytotherapy," "adverse-effects," "side • Cessation of event on stopping the They further advise monitoring patients effects," and "drug interactions." Ten major drug who take ginkgo (Ginkgo biloba L. , herbal product manufacturers were asked • Recurrence of event with rechallenge Ginkgoaceae), garlic (Allium sativum L., for data on interactions; eight experts and [with the suspected interacting herb Alliaceae), Chinese salvi a or dan shen 24 organizations were asked for further drug] (Salvia miltiorrhiza Bunge, Laniaceae) or information. Four major reference texts, six A score of 0- 3 was considered unevalu other herbs that affect platelet function for recent rev iew articles (s ince 1993), the able, 4-7 implied some evidence for an possible interactions with anticoagulant authors' files, and the bibliographies of all interaction (possible), and 8-10 indicated a drugs. articles used were also searched. well-documented report with reliable Although the authors state that even well A 10-point scoring system assessed inter evidence for interaction (likely). documented case reports can only serve as action probability. The scoring system, The search of all listed sources produced an early warning system, they urge those 22 I HerbaiGram 57 2003 www.herbalgram.org who publish case reports to document all coherent, usable form, and the discussion drug interactions, based on the well-docu rel evant information, including known provides in-depth analys is of the biochemi mented reliabili ty of the reports. It is ava il biochemical interactions. Case reports cal bases for herb-drug interactions. The able in the sa mple HerbClip section on should clearly describe the adverse event, summary table provides an opportunity to ABC's website, eviewed: Penzak SR, Jann MW, Cold (240 mL) in the evening at home, waited 8 sy nephrine in rh e 8 sa mples was 56.9 ± 0.52 RJA, Yi YH, Desai HD, Gurley B]. hours, and then drank the second 8 ounces micrograms/milliliter [fo r an equivalent Seville (sour) orange juice: synephrine (240 mL) the next morning at the labora dose of about 27 mg per 16 ounces of BOJ ], content and cardiovascular effects in tory. From the time the second dose was and no octopamine was detected in any of normotensive adults. journal of Clinical ingested (baseline) until 5 hours later, the sa mples. The researchers also tested Pharmacology 2001 ;41: I 059-63. o range juice made from frozen Bitter orange juice, called Seville concenrrate and found rhat it orange in this paper, is obtained from contained no octopamme o r the fruit and rind of the bitter orange synephrine. (Citrus x aurantium L., Ru taceae, T he authors conclude that "the treated by so me as a hybrid between lack of an effect on hemodynamic the pumello or shaddock C. maxima parameters in healthy vo lunteers (Burm.) Merr. , and the mandarin C. stro ngly suggests that the juice reticulata Blanco). Typically used for [BOJ) is safe to administer in 8- weight loss, bitter orange is used often ounce [240 mL] portions to as a substitute for ephedra (Ephedra normotensive, healthy individuals. " sinica Stapf, Ephedraceae). The fruit However, rhey say that the same and rind of the bitter orange contain precautions recommended when octopamine and m-synephrine using phenylephrine-containing (phenylephrine). These substances are decongestanr products also apply to both sympathomimetic amines [as are consumptio n of BO]. Most the ephedrine alkaloids found in notably, MAO inhibitors greatly ephedra; they produce a stimul ant increase th e abso rption of phenyle "fi ght or Ai ght" response in the body). phrine, which may potentiate its Freshly sq ueezed juice is often Bitter orange Citrus x aurantium Photo© 2003 stevenfosteccom ca rdi ac and hypertensive effects. given to subjects in drug metabolism The authors add, "s imilar to studies because bitter orange juice (BOJ) hourly meas uremenrs were made of the phenylephrine-containing oral prepara has the effect of "knocking out" the intes subjects' systolic blood press ure, diastolic tions, BOJ is best avoided in individuals tinal cytochrome P450 isoenzyme CYP blood press ure, mean arteri al press ure, and with severe hypertension, tachyarrhyth mi as 3A4, which is res ponsible for metabolism of heart rate. [a ny disturbance of rhe heart's rhythm, numerous drugs including cyclosporine, The res ults showed that BOJ had no regular or irregular, resulting in a rare over indinavir, and digoxin, and thereby reveal significa nt effects on any of the cardiovas I 00 beats per minute], or narrow-angle ing the relative contributions of intes tinal cul ar variables measured. T here were no g l a u coma." ~ metabolism to the absorption of medica adverse effects of ei ther the BOJ or the -Christina Chase, M.S., R.D. tions. water. The mea n concentration of The reseachers analyzed BOJ to measure its synephrine and octopamine contents and its effects on blood pressure and heart rate in healthy human volunteers. The subjects were I 0 men and 2 women, aged HerbClip™ The preceding Research Reviews are 20 to 27 years, with normal blood press ure. drawn from nearly 2,000 critical reviews In this crossover, open-label study, each available online to members of ABC at the subject ingested 16 ounces (480 mL) of Academic level and above. The full HerbClip Educational Mailing Service is distrib BOJ on one day and 16 ounces (480 mL) of uted bimonthly and includes 12 critical reviews along with many of the original arti water on another day, with a 7-day washout cles drawn from a variety of professional and mainstream sources. To receive the full period between study days. For both the service, contact Wayne Si lverman, PhD, at 512/926-4900 ext. 120, or via email at BO] and water, subjects drank 8 ounces Reviewed: Tauchert M. Summary: A randomized, double consisted of24 subjective complaints according to von Zerssen (a Efficacy and safety of blind, placebo-controlled clinical trial subjective symptom rating scale consisting of 24 individual Crataegus extract WS was designed to study the efficacy of a complaints). Patients reported the individual symptoms and 1442 in comparison standardized hawthorn ( Crataegus complaints from 0 (not present) to 3 (severe). Efficacy and toler with placebo in patients monogyna Jacq. or C. laevigata (Poir.) ability were ranked as either very good, good, moderate, or poor with chronic stable New DC.; Rosacea; syn. C. oxyacantha by both the patient and the investigators at the beginning and York Heart Association auct.) leaves with flower extract (WS end of the trial. class-III heart failure. 1442*) in patients with congestive Two hundred nine patients completed the trial (1,800 mg per American Heart journal heart failure (CHF). Two hundred day ofWS 1442 [n = 69], 900 mg per day ofWS 1442 [n = 70], 2002;143:910- 5. thirty-two male and female patients placebo (n = 70]). After the 16 weeks of treatment, the maximum (;;;, 40 years old) with chronic, stable tolerated workload showed a statistically significant increase in congestive heart failure (New York the 1,800 mg WS 1442 group when compared to both the 900 Heart Association (NYHA] class mg WS 1442 group (p = 0.01) and placebo (p = 0.013). Percent III**) for at least six months were entered in the trial. Eligible age of patients with improvement in maximal workload tolerated patients were previously untreated or treated with a diuretic was 52.2 percent of the 1,800 mg group, 34.3 percent for the 900 and/or with a low dose of an angiotensin-converting enzyme mg group, and 42.9 percent in the placebo group. Deterioration (ACE) inhibitor and had an exercise capacity of :s 75 watts (W) of maximal workload was reported in 5.8 percent of the 1,800 mg as assessed by seated bicycle ergometry. Following a four-week group compared to 12.9 percent and 17.1 percent for the 900 mg single-blind run-in phase (during which patients took placebo and placebo groups, respectively. Heart failure symptoms a.s rated tablets twice daily in addition to the combination of 50 mg of by the patients were reduced to a significantly greater extent in triamterene and 25 mg of hydrochlorothiazide [diuretic drugs] both WS 1442 groups as compared to placebo (p = 0.004 for the once daily in the morning), patients were randomized to take 1,800 mg group; p = 0.04 for the 900 mg group). Similar results either 450 mg WS were also found in using the von Zerssen scale (p = 0.03 for both 1442, 900 mg WS groups compared to placebo). Therapeutic efficacy was judged to 1442, or placebo two be very good more often in the 1,800 mg group than the 900 mg times per day for 16 WS 1442 group and placebo by both the investigators and the weeks. Patients also patients. Twice as many adverse events were reported in the continued the above placebo group compared to both WS 1442 groups. Ten percent diuretic regimen of patients in the placebo group complained of dizziness or throughout the trial. vertigo while only 4.3 percent of patients in the 900 mg WS 1442 Exercise capacity was group and 1.4 percent of patients in the 1800 mg WS 1442 assessed by use of group complained of these symptoms. seated bicycle ergome Comments/Opinions: Modern development of hawthorn try with incremental extracts in Europe began with the discovery that individual increases in workload flavonoids and flavonoid complexes are responsible for the cardiac at the beginning of the actions attributed to the plant. Among these are oligomeric study, at the end of the proanthocyanidins, vitexin, vitexin 4' -0-rha.mnoside, quercetin, run-in phase, and at 8 rutin, and hyperoside. 1 According to some sources, the leaves and and 16 weeks. The flowers contain the highest concentration of these active primary efficacy vari constituents, especially the oligomeric proanthocyanidins.2 able was the maxi The following pharmacodynamic effects have been demon mum workload toler strated in both in vitro and in vivo studies with hawthorn ated. Blood pressure extracts:3-5 and heart rate were 1) increased contractility of the myocardium, or middle layer of assessed at the end of the heart, consisting of cardiac muscle (positive inotropic each exercise stage. effect, or strengthened muscular action); Hawthorn Crataegus monogyna or C.laevigata. Patients' subjective 2) reduced peripheral vascular resistance (reduction in after- Photo © 2003 stevenfostercom symptoms were load); recorded at four-week 3) improved left ventricular ejection fraction; intervals during the trial. The first assessment encompassed the 4) improved coronary blood flow; and four typical heart failure symptoms - reduction in general 5) increased tolerance of the myocardium to oxygen deficiency. capacity, lassitude, early fatigue, and effort dyspnea (difficulty The mechanism underlying these effects is primarily attributed breathing, often associated with lung or heart disease and result to a slight inhibition of sodium/potassium adenosine triphos ing in shortness of breath). The second subjective assessment phatase (Na+IK+ ATPase), which might be responsible for the 24 I HerbaiGram 57 2003 www.herbalgra m.org positive inotropic action. There is also evidence of inhibition of The longest placebo-controlled trial with WS 1442 for CHF ACE and of interactions with the cAMP (cyclic adenosine patients has been the new 16-week trial summarized above. While monophosphate) mediated beta-adrenergic system, which may other placebo-controlled trials and the open-label 24-week trial explain the vascular effects of the extract. 6 suggest that WS 1442 is safe and efficacious for on-going use, In contrast to this new trial, earli er clinical trials using WS 1442 longer trials are needed to determine the long-term use of have been completed primarily with class II CHF patients. Two hawthorn extracts on mortality and morbidity from a large patient placebo-controlled trials found that C HF patients taking 160 cohort. Currently, a 24-monrh randomized, placebo-controlled mg/day of WS 1442 for 8 weeks had improved exe rcise tolerance trial is taking place in seven European co untries to study the influ and decreased heart rate during exercise (a stationary bicycle was ence of WS 1442 on the mortali ty of class II and Ill CHF the form of exercise) J·8 A 12- patientsY Billed the "SPICE" week placebo-controlled trial study (Survival and Prognosis: found increased exercise toler Investigation of Crataegus ance for class II C HF patients ex tract WS 1442 in Congestive taking 240 mg/day of WS Heart Fai lure), the trial wi ll 1442.9 However, the difference randomize up to 2,300 class II in exercise tolerance between or III CHF patients to receive the WS 1442 and placebo either 900 mg/day of WS 1442 group failed to reach statistical or placebo for 24 months while significance (p = 0.06). An continuing any preexisting drug uncontrolled, open-label study therapy for CHF. This wi ll found that 900 mg/day of WS provide not only long-term data 1442 for 24 weeks also led to on efficacy and safety (includ improved exercise tolerance, ing potential drug interactions) decreased blood pressure, and for WS 1442 therapy but also improved left ventricular ejec determine its influence on tion fraction (LVEF) in 1,011 cardiac endpoints such as class II C H F patients.10 In a Hawthorn Crataegus monogyna or C.laevigata. Photo © 2003 stevenfoster.com sudden death, non-lethal small clinical trial, 40 class II myocardial infarction, and CHF pati ents with a LVEF of less than 55 percent were random hospitalization due to progression of heart fai lure. The trial was ized to receive either 480 mg/day of WS 1442 or placebo for 4 due to be completed at the end of 2002. weeks. 11 At the end of the trial, there was a 1.5 percent increase in Practice Implications: Earli er clinical trials have found that the LVEF under exercise conditions (s tationary bicycle) in the WS daily doses of 160-900 mg ofWS 1442 (the dosage level recom 1442 group compared to a 0.2 percent decrease in LVEF in the mended by the German Commission E based on previous trials 13) placebo group (p = 0.0002). During rest, LVEF increased by 2.5 have been effective in increasing exercise tolerance in NYHA class percent in the WS 1442 group compared to a 0.3 percent decrease II CHF patients. This trial is the first to study patients with more in the placebo group (p = 0.0001). Continues on page 28 Note: WS 1442 is a standardized ethanolic extract (4-6.6:1) of hawthorn leaves with flowers produced by the Dr. Willmar Schwabe Co. of Karlsruhe, Germany. T he extract is standardized to contain 18.75 percent oligomeric proanthocyanidins. Sold under the regis tered trade name Craraegutt® in Europe, the extract is sold in the United States by Nature's Way Products, Inc. as HearrCare® and by their professional subsidiary MMS Pro as Cardi-Plant™ Pro. •• Note: In order to monitor the progression of C H F, an index called the New York Heart Association (NYHA) classification has been developed. The scale ranges from Class I to Class IV. Symptoms associated with the classes are as follows: Class 1: No limitations of physical activiry. Ordinary physical acriv iry does nor cause undue fatigue, dyspnea, palpitations, or angina. Class II: Slight limitation of physical acriviry. Such patients are comfortable at rest. Ordinary physical acriviry may result in fatigue, dyspnea, palpitations, or angin a. Class III: Marked limitation of physical acri viry. These patients are fairly comfortabl e at rest. Less than ordinary physical activiry will lead to symptoms. Class IV: Inabili ry to carry on any physical acriviry without discom fo rt. Symptoms of heart failure or angina are present even at rest. If any physical activi ry is undertaken, increased discomfort is experi enced. www.herbalgram.org 2003 HerbalGram 57 I 25 Clinical Update by Donald J. Brown, N.D. St. John's Wort Extract Effectively Treats Mild to Moderate Depression in Large French Trial Reviewed: Lecrubier Y, Summary: A randomized, double After randomization, 18 patients from the SJW group and 25 Clerc G, Oidi R, Kieser blind, placebo-controlled clinical trial from the placebo group terminated treatment prematurely. The M. Efficacy of St. John's was designed to study the efficacy of primary reasons for earl y withdrawal were lack of efficacy (SJW: wort extract WS 5570 in St. John's wort (Hypericum perfora n = 10; placebo: n = 14) , revocation of informed consent (SJW: n major depression: A tum L., Clusiaceae alt. Guttiferae, = 4; placebo: n = 7), and adverse events (SJW: n = 2; placebo: n double-blind, placebo also placed in Hypericaceae) in = 2). However, all patients were included in the intention-to-treat controlled trial. American patients with mild to moderate major analysis (i.e., all patients, even those who dropped out, were journal ofPsy chiatry 2002 depression. Patients were eligible for included in the final statistical analysis). August; 159(8): 1361-6. the study if they had a current major From baseline to the end of the trial (day 42), the total score depressive episode of at least rwo for the HAM-D decreased by a mean of 9.9 points (Standard weeks duration (single or recurrent episode according to Diagnos Deviation [SD] = 6.8) for the SJW group and 8.1 (SO= 7. 1) in tic and Statistical Manual of Mental Disorders, Fourth Edition the placebo group (the baseline mean HAM-0 score was 21.9 [DSM-IV] criteria), had a total score on the Hamilton Depres points [SD = 1. 7] for both groups). In the intention to treat sion Scale (HAM-D) berween 18 and 25 and a score on item 1 analysis, the percentage of responders was significantly higher for ("depressed mood") of 2 or higher at screening and baseline. SJW (52.7 percent) than for placebo (42.3 percent; p < 0.05). Patients were recruited The percentage of patients with remiss ion was significantly from a pool of patients higher for the SJW group (24.7 percent) than for placebo (15.9 who sought treatment percent; p = 0.03). Among the patients receiving WS 5570, the for depression at 26 difference in the decrease in the HAM-D total score berween medical and research baseline and treatment termination was larger in the subgroup of centers in France. patients with initial scores 2: 22 points. Compared to placebo After a single-blind, patients with a similar HAM-D score, this decrease was signifi placebo run-in period, cantly greater in the SJW group (p = 0.04). The decrease in 375 male and female patients with scores berween 18 and 21 did not differ significantly patients (ages 18 to 65 from the placebo group. The mean decrease on the total score of years) were random the MADRS was 11.7 points (SD = 9.0) for the SJW group and ized to take either 300 9.9 points (SD = 9.2) for the placebo group- a difference that mg of St. John's wort did not reach significance (p = 0.06). There was also no signifi (SJW) extract WS cant difference berween groups on the SCL-58 depression 5570* (Dr. Willmar subscore. The score on the Bech melancholia subscale decreased Schwabe Pharmaceu by a mean of 5.5 points (SD = 4.2) in the SJW group and 4.4 ticals, Karlsruhe, points (SD = 4.1) in the placebo group (p = 0.001). During the Germany) or placebo trial, 30.6 percent of patients taking SJW experienced adverse 3 times per day for 6 events compared to 37 percent in the placebo group. Most of weeks. The primary these were mild in nature and included nausea, headache, dizzi outcome measure was ness, abdominal pain, and insomnia. the change from base Comments/Opinions: Following the publication in the jour line in total score on nal ofthe American Medical Association during the past rwo years St. John's wort Hypericum perforotum. the 17-item HAM-D of rwo well-publicized negative clinical trials conducted in the Photo © 2003 stevenfoster.com berween baseline and United States, 1•2 many skeptics of SJW as an herbal antidepressant subsequent visits (patients were evaluated at 7, 14, 28, and 42 suggested it was ineffective. Advocates of the herb's effectiveness days). In addition, analysis of responders (patienrs with at least a suggested that these trials looked at the wrong group of patients, 50 percent reduction in the HAM-D) and patients with remis pointing out that previous European trials had found SJW effec sion (patients with a total score of 6 or less on the HAM-D at tive for treating mild to moderate depression. Finally, many treatment end) was also completed. Secondary measures of effi experts knowledgeable of clinical trials on approved conventional cacy were the total score on the Montgomery-Asberg Depression antidepressant drugs pointed out that many placebo-controlled Rating Scale (MADRS), the score on the 25-item version of the trials with these drugs fail to show a significant effect- about 35 Symptom Check List (SCL-58), the Bech melancholia subscale percent of these trials routinely fail, a fact acknowledged in the (BMS), and the C linical Global Impression (CGI). NIH SJW trial itselP - often due to the study lacking enough sensitiviry to detect a difference berween active medication and The WS 5570 product is a hydroalcoholic St. John's wort extract placebo. (4-7: I) standardized w 3-6 percent hyperforin and 0.12- 2.8 Now, the gap berween positive European trials and negative percent hypericin. A similar extract is imported inw the United clinical rrials on SJW only gets wider with the publication of this States and marketed as Perika®by Nature's Way of Springville, Utah. French trial. A well-designed study conducted by one of France's 26 I HerbalGram 57 2003 www.herbalgram.org most respected psychiatric researchers, the Lecrubier erial rivals used as the dividing point between those less severely depressed 1 both U.S. trials •2 in use of standard methods and addresses many and those with more moderate to severe depression. It is interest of the questions and critiques that have plagued earlier European ing that the lack of response in a sub-analysis of patients with trials with SJW. The largest placebo-controlled trial to date on HAM-0 scores below 22 is consistent with the Shelton trial SJW for depression, the results counter those of the two U.S. trials published in JAMA. in 2001. 1 While this result may contrast with by finding a significant antidepressant effect for SJW in a patient those advocating the use of SJW for those with milder depression, population with mild to moderate depression. However, a few it's important to keep in mind that demonstrating a clinical effect differences between this erial and the two U.S. erials should be gets more difficult as the severity of the condition decreases. Future noted. clinical trials may have to focus on this group with milder depres First, the Lecrubier trial recruited patients who were routed sion using larger patient populations. Based on the fact that SJW through their attempts to seek treatment without incentive, as is an over-the-counter dietary supplement, backing it even further opposed to the U.S. trials, which recruited by newspapers, televi down the spectrum of severity to a condition such as dysthymia (a sion, and radio, usually with some incentive such as money. Jerry mood disorder characterized by despondency or mild depression) Cott, Ph.D ., an expert on makes se nse as well. analyzing clinical erials on SJW As reported extensively and formerly a researcher with during the past few years, the National Institutes of healthcare professionals should Mental Health says, 'This is be aware of the potential for significant because the patients drug interactions in patients in the French trial are more taking SJW. Case reports and/or 'real world' compared to those pharmacological studies have entering into clinical trials in demonstrated that SJW may the United States who tend to reduce serum levels of the suffer from more chronic forms following drugs: indinavir, of depression that are usually cyclosporine, theophylline, less responsive to therapeutic digoxin, warfarin, and oral birth intervention."3 control pills.6• 14 A recent phar Second, the entry criteria macological study also suggests based on HAM-0 scores is that irinotecan (a chemothera different. With an upper range peutic drug) metabolism effects of 25 on the HAM-0, the may be altered by SJW. IS St. John 's wort Hypericum perforatum. Photo © 2003 stevenfoster.com Lecrubier study sets a low range Concomitant use ofSJW extract of 18 for inclusion. The two U.S. trials set their lower range of the with selective serotonin reuptake inhibitors (SSRls) has resu lted in HAM-0 at 20 with no upper range established at recruitment. serotonin syndrome (a condition caused by excess serotonin that The NIH trial ended up with upper range HAM-0 baseline scores may result in mental confusion, muscle twitching, sweating, flush of 33. 2 This suggests that the French trial had a more defined ing, and tachycardia; in more severe cases, it can cause coma and patient population, elim inating those patients with more severe even death) in two cases 16•17 and is reported in two individuals in a major depression. report on the safety and efficacy of SJW based on a local survey Finally, the dosage used in the French trial (900 mg/day) was completed by the University of Missouri. 18 consistent with the majority of European trials on SJW While the Patients taking SJW as an antidepressant should be closely ques two U.S. trials started out at this dosage, patients were allowed to tioned about any history of bipolar disorder or hypomania (a mild move to higher doses of either 1,2 00 mg1 or I ,500 mg2 if they were form of mania, characterized by hyperactivity and euphoria). unresponsive at the lower dose. The French trial also used a SJW There have been several case reports of SJW causing mania in extract with a standardized concentration of hyperforin while the patients with this history. Ironically, this may be another indicator U.S. trials used an extract (LI 160, Lichtwer Pharma, Berlin, of the efficacy of SJW as an antidepressant as this condition is Germany) that does not publically claim standardization to hyper commonly reported with prescription antidepressants as well. 19·22 forin levels on the product's label, but does contain hyperforin, as Practice Implications: This new French clinical trial adds determined by the company's own analyses. 4 further evidence of the safety and efficacy ofSJW for the treatment It should also be noted that while the Lecrubier trial was of mild to moderate depression. As has been noted in earlier SJW placebo-controlled, it did not have a third arm containing an active trials as well as many drug trials for depression, the placebo drug group such as that used in the NIH trial. 2 It is interesting to response (42.3 percent) was very high and must be considered note that in the NIH trial, the group taking sertraline (Zoloft®, when treating patients with any antidepressant, including SJW. Pfizer, New York, NY) did not show significant clinical benefits Healthcare professionals should closely advise _patients wishing to compared to placebo (as noted in Cott's analysis of the trial in take SJW about potential drug interactions. A Herba/Gram 56).5 In the French trial, patients with HAM-0 scores between 22 and 25 taking SJW were more likely to have a clin ical effect while Continues on page 28 those below 22 were not. A total HAM-0 score of22 is sometimes www.herbalgram.org 2003 HerbaiGram 57 I 27 ST. ]OHN'S WORT II. Nebel A, Schneider BJ , Baker RK, Kroll OJ. Potential metabolic interaction between St. John's wort and theophylline [letter]. Ann Continued from page 27 Pharmacother 1999;33:502. Author's Note: Thanks to jerry Cott, Ph.D., for his feedback on the 12 . Maurer A, Johne A, Bauer S, et al. Interaction of Sr. John's wort design ofthis and other S}W clinical trials. ex tract with phenprocoumon [abstract]. Eur J Clin Pharmacal 1999;55:A22. References: 13. Johne A, Brockmoller J, Bauer S, et al. Pharmacokinetic interaction I. Shelton RC, Keller MB, Gelenberg A, et al. Effectiveness of St. John's of digoxin with an herbal extract from St. John's wort (Hypericum won tn major depression: A randomized trial. JAMA perforatum). Clin Pharmacal Ther 1999;66:338-45. 200 I ;285: 1978-86. 14 . Ernst E. Second thoughts about safery of St. John's wort [letter]. 2. Hypericum Depression Trial Group. Effect of Hypericum perforatum Lancet 1999;354:20 14-6. (St. John's wort) in major depressive disorder. JAMA 2002;287: 1807- 15 . Mathijssen RHJ , Verweij J, de Bruijn P, et al. Effects of Sr. John's 14. wort on irinotecan metabolism. j Nat! Cancer lnst 2002;94: 1247-9. 16. Demott K. Sr. John's wort tied to serotonin syndrome. Clin Psychia 3. American Botanical Council. Sr. John's Wort Study Misinterpreted Says Herbal Science Group [press release]. 2002 April 6. try News 1998;26:28. 4. Schulz V. Hyperforin values: By no mea ns just "traces" [letter]. 17. Gordon JB. SSR!s and St. John's wort: possible toxicity? Am Family Deutsche Apotheker Zeitung 1998; 138(6). Physician 1998;57:950. 5. Con J. Press releases freely interpret failed study and claims that Sr. 18. Bekman SE, Sommi RW, Switzer J. Consumer use of St. John's wort: John's wort doesn't work. Herba!Gram 2002;56:22-3. A survey on effectiveness, safery, and tolerability. Pharmacotherapy 6. Piscitelli SC, Burstein AH, Chaitt D, et al. lndinavir concentrations 2000;20:568-74. and Sr. John's wort [letter]. Lancet 2000;355:547-8. 19. Nierenberg AA, BurtT, Matthews J, Weiss AP. Mania associated with 7. Ruschitzka F, Meier P, Turina M, et al. Acute transplant rejection due Sr. John's wort. Bioi Psychiatry 1999;46: 1707-8. to Saint John's wort [letter]. Lancet 2000;355:548-9. 20. Moses EL, Mallinger AG. Sr. John's wort: Three cases of possible 8. Breidenbach T, Hoffmann MW, BeckerT, et al. Drug interaction of mania induction. j Clin Psychopharmaco/2000;20:115-7 . Sr. John's wort with ciclopsorin [letter] . Lancet 2000;355: 1912. 2 1. O'Breasail AM, Argouarch S. Hypomania and StJohn's wort [letter]. 9. Karilova M, Treichel U, Malago M, et al. Interaction of Hypericum Can j Psychiatry 1998;43:746--7. perforatum (St. John's wort) with cyclosporine A metabolism in a 22. Schneck C. Sr. John's wort and hypo mania [letter]. J Clin Psychiatry patient after liver transplantation. J Hepatology 2000;33:853-5. 1998;59:689. I 0. Barone GW, Gurley BJ, Ketel BL, et al. Drug interaction between St. John's wort and cyclosporine. Ann Pharmacother 2000;34: I 013-6. HAWTHORN 2000;35:700-707. 6. Loew D. Pharmacological and clinical results with Crataegus special Continued from page 25 ex tracts in cardiac insufficiency. ESCOP Phytotelegram 1994;6:20-6. severe class Ill CHF and finds that a higher daily dose of I ,800 7. Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus special mg is more effective than 900 mg in improving exercise tolerance extract WS 1442: Objective proof of efficacy in patients with cardiac insufficiency (NYHA II). Fortschr Med 1996;114:291- 6. as well as improving subjective symptoms of CHF. Due to the 8. Leuchtgens H. Crataegus special extract (WS 1442) in cardiac insuf varied dosages used in previous trials with class II patients, future ficien cy. Fortschr Med 1993; Ill :352-4. trials should determine the optimal therapeutic dosage for this 9. Zapfe G. Clinical efficacy of Crataegus extract WS 1442 in conges patient group. According to the literature, there are no known tive heart failure NYHA class II. Phytomedicine 2001 ;8:262-6. interactions of hawthorn extracts with prescription cardiac 10. Tauchert M , Gildor A, Lipinski J. High-dose Crataegus extract WS drugs. 13· IS Although the potential for hawthorn extracts to poten 1442 in the trea tment of NYH.A Stage II ca rdiac insuffi ciency. Herz tiate (i.e., to make more powerful, especiall y a drug) the effect of 1999;24:465-74. digoxin has been suggested by some authors, 14 this has not been II. Eichstadt H , Stork T, Mockel M, et al. Efficacy and tolerability of C rataegus extract WS 1442 in patients with congestive heart fai lure documented in any clinical trials to date nor has it been cited as a and impaired left-ventricular function. PerfUsion 2001;14:212-7. 13 concern by either the German Commission £, the American 12. Holubarsch CJF, Colucci WS, Meinertz T, et al. Survival and prog 1 Herbal Pharmacopoeia, 5 or the American Botanical CounciJ16 nosis: Investigation of Crataegus extract WS 1442 in congestive heart monographs on hawthorn. --" fa ilure (SPICE)- rationale, study design and study protocol. Eur j Heart Failure 2000;2:431 -7. References: 13. Tanzler VG, Schuler E. Verleichende studein uber wirkungen eines I. Loew D. Pharmacological and clinical results with Crataegus special Crataegus-exrraktes, ven digitoxin, digoxin, und y-srrophanthin am extracts in cardiac insufficiency. ESCOP Phytotelegram 1994;6:20-6. isolierten warmbiLiterherzen. Arzneimittlforschung Drug Res 2. Rewerski VW, Piechocki T, Rylski M, Lewak S. Some pharmacolog 1962; 12:198. ical properties of oligomeric procya nidin isolated from hawthorn 14. Blumenthal M , Busse WR, Goldberg A, Gruenwald J, Hall T, ( Crataegus oxyacantha). A rz neimittelforschung Drug Res Riggins CW, Rister RS , ed itors. Klein S, Rister RS, translators. The 1967;1 7:490-1. Complete German Commission E Monographs: Therapeutic Guide to 3. Chatterjee SS, Koch E, Jaggy H, Krze minski T. In vitro and in vivo Herbal Medicines. Austin (TX): American Botanical Council; Boston investigations on the cardioprotective effects of oligomeric procyani (MA): Integrative Medicine Communication; 1998. dins in a Crataegus extract from leaves with flowers. Arzneimittl 15 . Upton R, ed. Hawthorn leaf with flower. Santa Cruz, CA: American forschung Drug Res 1997;47:821-5. H erbal Pharmacopoeia, 1999. 4. Weikl A, Noh HS. The influence of Crataegus on global cardiac 16. Blumenrhal M, Hall T, Goldberg A, Kunz T, Dinda K, Brinckmann insufficiency. Herz Gefobe 1993; II :5 16--24. J, et al. , editors. The ABC Clinical Guide to Herbs. Austin (TX): 5. Schwinger RHG, Pietsch M , Frank K, Brixus K. Crataegus special American Botanical Council; 2003. ex tract WS 1442 increases force of contraction in human myocardium cAMP-independently. j Cardiovasc Pharmacal 28 I HerbaiGram 57 2003 www.herbalgram.org D EAR READER Manufacturing Practices (GMPs) because the "botanical industry Continued .from page 4 has consistently blocked" their release. Au contraire! Not only have trade groups (like the American dementia carries much more weight than a single study published Herbal Products Association, Consumer Healthcare Products Asso in either JAMA or NEJM (no disrespect intended to either journal). ciation, Council for Responsible Nutrition, and National Nutri However, the following week CNN and many newspapers ran tional Foods Association) been pushing for publication of GMPs stories on a clinical trial by Bruce Barrett, Ph.D., published in the during the past several years, the original draft version of GMPs Annals ofInternal Medicine. Dried echinacea powder failed to show published by FDA in 1997 were prepared primarily by industry significant benefits compared to a placebo (alfalfa) in college quality control experts! If anyone wants to see federally mandated students who experienced upper respiratory tract symptoms associ GMPs for herbs and other dietary supplements (and stands to bene ated with common cold. News stories carried headlines like "Echi fit from the eventual enforcement of such, if and when the FDA nacea no cold cure, study says." There was little mention that the does enforce the rules) , it's the supplement industry. (Note: Current study and the product were not consistent with previous positive food GMPs are still operative for all dietary supplements; new trials, usually based on liquid extracts or fresh-pressed juice, or that supplement GMPs will add more controls and processes specific to the study was conducted four years earlier on a product no longer the manufacture of herbal and other supplement products.) NEJM sold. (See Dr. Barrett's review of the safety of echinacea in this got this totally wrong, and the fact that the statement was not refer issue.) enced is telling. How did this pass peer review? Apparently, the During a recent radio interview on a major metropolitan station, authors and the journal's reviewers are not adequately versed in the I was asked, "Is there a conspiracy or bias in the medical establish intricacies and nuances of herb regulation. ment and media against herbs?" There are other areas where we either did or did not agree with "Conspiracy? Who knows?" I responded. "I don't have any direct the NEJM regulations editorial, as noted in our press release issued evidence." (Readers are invited to send me their evidence of"smok on December 18, also available on ABC's website. ing guns" for consideration.) "Bias? Yes , definitely," I added, offer Where to go from here? It's imperative that all media sources - ing the following example. whether consumer, trade, or professionally oriented - exercise as In mid-December NEJM published a trio of articles on herbs: a much diligence as possible to report herb research and news about lengthy review of four top-selling herbs, an editorial on regulation, research in an accurate manner. This is our goal at ABC and and a brief editorial on both by Stephen Straus, M .D., director of HerbaLGram, and I know it is shared by other publications too. the National Center for Complementary and Alternative Medicine Unfortunately, sometimes (too often) many fall short of their at NIH. Dr. Straus called the use of herbs "a public health experi responsibilities to the public. --' ment." Drs. Donald Marcus and Arthur GroHman's regulatory editorial included an unreferenced statement that erroneously suggests that FDA has not yet published their long-awaited Good STEVEN FOSTER GROUP , I N C . eatured in HerbaiGram for over a decade, the photographs of Steven Foster are available for licensing for editorial or commercial projects. Specializing in medicinal and aromatic plants, our stock photo files include more than 70,000 images, including most major herbs sold as dietary supplements. Steven Foster Group , In c. Ellw Miller, Vice President, Sales and Marketing P.O . Box 1343 Fayetteville, AR 72702 479-521-5887 fax 479-521-6369 em a i I: emiller@stevenfoster. com www. stevenjoster. com COME TO THE SO U RCE www.herbalgram.org 2003 HerbaiGram 57 I 29 Panax ginseng; courtesy of Pharmaton SA., Lugano-Bioggio/Switzerland by Dennis V. C. Awang , Ph.D., F.C. I.C The Impostors he herbal marketplace has bee n subj ected frequently to a The most prominent pretender to the mantle of "ginseng" is so va ri ety of strategies calcul ated to promote product sales, called "S iberian ginseng," now known by the standard ized T rather than to adva nce the science and understanding of common name of eleuthero (Eleutherococcus senticosus (Rupr. & medicinal plants and their appropriate applications. In some Maxim.) Maxim.).* Also a member of the fami ly Araliaceae, as are particularl y egregious cases, the appellation "ginseng" has been the Panax species, the root of this plant is claimed to exert similar abused by uninformed or even unscrupulous peddlers of herbal effects on the body. 10 In addition to the more appropriate common preparati ons, who clearl y seek to cash in on the reputation of the des ignati on of eleuthero (generall y preferred by the botanicall y legendary Asian root. knowledgeable), the plant has also been referred to as "Russian," G inse ng, or, in Chinese, ren-shen, has been translated roughl y as "s pi ny," or "eleuthero ginseng," as well as eleurherococcus, prickly "man-root. " Fulder states that the Chinese characters for ginse ng, or spin y eleurherococc, touch-me-not, devil's bush, Ussurian both the common name and spec ifi c epithet for Asian or Oriental thorn y pepperbush, taiga, and wild pepper. The term Manchurian gi nseng, represent ideas rather than sounds.' Ren embraces multiple ginse ng may also relate to eleurhero. Eleutherococcus gracilistylus concepts, including "the spirit of man or the shape and dimensions (W.W. Sm.) S.Y. H u has also been termed "prickly ginseng." of man. Shen, seng, or sang means root, but al so a 'crystalli zati on of Eleuthero is nor a "seng-producing" plant since it has a woody, nor the esse nce of the earth'." Hu in her 1976 review explained, "Seng fl eshy, roorsrock. Further, as noted earlier, only roots of Panax species is .. . a term used by C hinese medi cin al plant collecrors for all fl eshy may legitimately be termed "ginseng," as now required by recent [rootstocks] used as tonic." 2 She al so listed 22 species of seng legislation in the United States, the Farm Security and Rural Invest producing plants from 12 genera in seven plant families of the ment Act of 2002.11.12 Hu3 states that use of the appell ation "Siberian Dicotyledoneae from Volume I of the Chinese Materia Medica. In ginseng," which first appeared associated with eleurhero imported a subsequent letter to botanist and author Steven Fosrer,J Hu in ro the United States in the 1970s, was a marketing stratagem 11 further ex panded her list of sengs to 62 species in 40 genera of 20 intended to capitalize on the popularity of traditional ginseng. · It fam il ies . O nly products deri ved fro m Panax species are properl y was subsequently adopted as an accepted common name in termed gin-seng. Unfortunately, Siegel, in his in fa mous article4 commerce by the now-defunct Herb Trade Association in the late referring ro a supposed G inseng Abuse Syndrome,5 stated erro 1970s, 14 and then dropped by the American Herbal Products Associ neously that "the term 'ginseng' can refer to any of 22 related ation (AHPA) in favor of the now-preferred term eleuthero in plants." AHP.A's Herbs ofCommerce ," its fi rst attempt to standardize common names for popular herbs in the U.S. marker. This publication, The Ginsengs superceded in 2000 by a second revised and expanded edition, 16 was The ge neri c name Panax is deri ved from the Greek pan, mean adopted by the U.S. Food and Drug Admi nistration as the official ing all , and akos, meaning remedy; panacea, meaning cure-all, standard for common names for commercial herb producrsY It is deri ves di recrl y fro m the Greek panakeia. possible that the second volu me wi ll also be so recognized. are those other "ginsengs"? Am eri can ginseng (P quinquefolius* L., Arali aceae) and dwarf or T he te rm "ginseng" has been further attached to a bewil deri ng groundnur (peanut) ginseng (P trifolius* L.) are native to North array of qualificati ons- national, geographic, color, among others Ameri ca. As ian ginsengt was firs t named Panax schin-seng T. Nees -for a stunning variety of no n-arali aceous species (see Table 2). in 1833 by T.F.L. Nees van Esenbeck. ln 1842, Carl Anton Meyer A somewhat common component of "multi-ginseng" formula re named the species Panax ginseng C.A. Meyer. Duke noted, tions is suma (Hebanthe eriantha (Pair.) Pederson, syn. Pfoffia "There are only about a dozen species of Panax in the world ," and paniculata (Mart.) Kuntze, Amaranthaceae), which is also called li sted nine.G "Brazilian" or "South American ginseng." Ashwagandha ( Withania T he most commercial ly important species of ginseng, after P somnifera (L.) D unaJ), Solanaceae) has been sold as "Indian" or ginseng and P quinquefolius, is P notoginseng (Bu rkill ) F. H . C hen ex "A yu rved ic ginseng." T he Indian herb jeevani ( Trichopus zeylanicus C.Y. Wu & K.M. Feng, commonly call ed T ienchi or Sanchi Gaert., D ioscoreaceae) has also been referred to as "Indian ginseng (in Chinese pinyi n, tien qi or san qz). T his species was ginse ng."18 Because of use of its roots to promote stamina and formerly referred to as P pseudoginseng Wall. var. notoginseng fertili ty, the recenrl y popularized maca (Lepidium meyenii Walp., (Burkill) G. H oo & C.] . Tseng. References to at least seven addi Brass icaceae) is referred to as "Peruvian ginseng" or "Ginseng of tional Panax taxa may be found, which were formerly designated the Andes." 19 And in the 1970s, canaigre or tanner's dock (Rumex as vari eti es or subspecies of P pseudoginseng Wall .? hymenosepalus To rr. , Polygonaceae) was advanced as "wild red Wen and Zimmer used DNA analys is to review the phylogenetic America n ginseng" or "wi ld red desert ginseng."20 (i. e., evolutionary development) relationships among Panax An advanced search on www.herbalgram .org 2003 Herba iGram 57 I 31 conrains ginsenosides. 8 G. pentaphyllum is the only non-Panax the attribution of common names to herbs is not as well-codified species known to contain these compounds. Pseudostellaria (Pseu as the use of scientific Latin binomials , there are accepted stan dostellaria heterophyl!a (Mig.) Pax, Caryophyll aceae) has been sold dards for nomenclature adopted by industry and the government as "prin ce's" or "lesse r ginseng."2 1 Fulder identifies "bastard to ensure accuracy and reduce confusion. Thus, the most basic ginseng" as Campanunoea pi!osu!e, 1 although it should be given as obligation to name products accurately is owed to consumers as Campanumoea pi!osu!a Franch., well as to health practitioners, regula Campanulaceae. Foster identifies this tors, academicians, and researchers of species by its basionym ( Codonopsis all inrerests. While taxonomists delve pi!osu!a (Franch.) Nannf., Campanu furrher in the intricacies of DNA laceae) . 22 structure to berrer organize human Blue cohosh ( Cau!ophy!!um tha!ic understa nding of the relatio nships troides (L.) Michx., Berberidaceae) has among plant species, manufacturers, been offered as both "blue" and healthcare professionals , a nd the "yellow ginseng."23 Other species, such general public should, at the very least, as adenophora (Adenophora triphyl!a be sure they know what, exactly, is (Thunb. ex Murray) A. DC., being sold and consumed. The result Campanulaceae), glehnia (G!ehnia ing credibility and respect, based upon !ittora!is F. Schmidt ex Mig., the facts rather rhan ignoranr or inac Apiaceae), fo-ri (Polygonum multiflo curate promotional claims, are vitally rum Thunb., Polygonaceae), C hinese important to the future of herbal salvia (Salvia miltiorrhiza Bunge, medicine, and the marketplace. --"' Lamiaceae), and species in the genus Two species of ginseng (dkar-po chig-thub-rigs gnyis gYa'-la skyes; Scrophularia, Scrophulariaceae, have Panax pseudoginseng Wall.); detail from Painting #26 of Exegetical Dennis V C. Awang, Ph.D., FC. !. C, reportedly also been sold as Tantra, Chapter Twenty: Materia Medica IV Herbal Medication s. is president of MediP!ant Consulting "ginseng. "2 1 Fang also reports rh ar ©The History Museum of Buryatia. with permission from Inc., based in White Rock, British even rhe peel of tangerine (Citrus retic Pro-Cultra, Inc. Columbia, Canada. ulata Blanco, Rutaceae) has been sold as "ginseng"!21 References: Toward the end of 1999, a Malaysian company introduced 1. Fulder S. The Book of Ginseng. Roch ester (VT): Healing Arts Press; "M alaysian ginseng" to Singapore, the Middle East, and Europe. 1993. p. 89. 2. Hu SY. The ge nus Panax (ginseng) in Chinese medicine. Econ Botany An internet documenr stated, "Ginse ng is more well-known 1976;30:11 -28. worldwide, as such we introduced Tongkat Ali as a type of root 3. Hu SY. 1979 March 20. Letter to S Foster. 24 that has the [sa me] nutritional value as ginseng." Apparently, 4. Siegel RK. Ginseng abuse sy ndrome.}AMA 1979;241:1614-5. tongkat ali (which translates to "Ali 's staff or walking stick") is a 5. Blumenthal M. Debunking the "Ginseng Abuse Syndrome." Whole generi c term for plants used as aphrodisiacs and tonics in Foods 1991 March:89-9 1. Malaysia .21 Foster has idenrified a number of prominent source 6. Duke JA. Ginseng: A Concise Handbook. Algonac (Ml): Referen ce pla nts for tongkat ali including, Eurycoma !ongifo!ia Jack, Publications, In c.; 1989. p. 14-7. Simarubaceae; Grewis umbellata Roxb. , Tiliaceae; Polyafthia 7. Wen J, Zimmer EA. Phylogeny and biogeography of Panax L. (th e ginseng genus, Araliaceae): Inferences from ITS sequences of nuclea r bul!ata King, Annonaceae; and Smilax calophyl!a Wall., Liliaceae or ribosomal DNA. Molecular Phylogenetics and Evolution 25 Smilaxaceae, but further research indicates the first species in this 1996;6(2) : 167-77. li st of prospects is involved in the commercial venture. 8. Due NM, Nham NT, Kasa i R, Ito A, Yamasaki K, Tanaka 0. The herbal community is working to achieve greater credibility Saponins from Vietnamese Ginseng. Panax vietnamensis HA et and respect for herbs and phytomedicines, and many healrhcare G RUSHV. Collected in Central Vi etnam. I. Chem Pharm Bull professionals are responding to public demand that they integrate 1993;4 1(1 1):2010-4 . herbal medicines in to their clinical practices . To support these 9. Wen ). Species diversity, nomencl ature, phylogeny, biogeography, laudable effortS, the information o n product labels, in promo and classification of the ginse ng gen us (Panax L. , Araliaceae). In: Pjnja ZK, ed itor. Utilization of biotechnological, genetic and cultural tional materials, and in scientific and popular literature must be approaches for North American and Asian ginseng improvement. accurate in every respect. Despite the fact that the rules governing Proceedings of th e lnrern arional Ginse ng Workshop. Vanco uve r, Canada: Simon Fraser University Press; 2001. p. 67-88. * Linnaeus used th e neu ter forms quinquefolium and triflolium for th ese 10. Awang DVC. Eleuthero. Can Pharm} 1996;129(8):52-4. specific epithets, bur Panax is masculine, requiring the 'ius' ending. In 11. Blumenthal M. Farm bill bans use of name "Ginseng" on non-Panax the arca ne logic of taxonomic nomenclature, th e Larin binomials Panax species: "Siberian Ginseng" no longe r allowed as co mmercial term. quinquefolius and P trifolius are perfectly acceptable, even though th e HerbalGram 2002;56:54-5. specific epithets, meaning "five-l ea fed" and "three-leafed," respectively, 12. 10 7th Congress. Farm Security and Rural Investment Act of 2002. are descriptively inaccurate and, as such , not a sensible basis for distin 107- 17 1. 32 I Herbal Gram 57 2003 www.herbalgram.org Rochester (VT): Healing Arts Press; 1992. p. 74. 1996;381: 182. 14. Blu menthal M. Personal communication, 2003 Jan uary 22. 19. Rea J. Raices andinas: maca. In: Bermejo H , Lon JE, ed itors. Cultivos 15. FosterS. H erbs ofCommerce. Austin, TX: American Herbal Products marginados, otra perspectiva de 1492. Rome: FAO; 1992. p. 163-6. Association, 1992. 20. Bl umenthal M. 1993 November 9. Memo to D Awang, HHS Fong, 16. McGuffi n M, KarteszjT, Leung AY, Tucker AO. Herbs ofCommerce. NR Fa rnsworth. 2nd edition. Si lver Spring (MD): American Herbal Products Associ 2 1. Fong HH S. 1996 November 4. Perso nal communicati on. ation, 2000. 22. FosterS. 1997 January 29. Personal communication. 17. 21 CFR § 10 1.4(h) 23. Farnsworth N R. NAPRALERT. University of Ill inois at C hicago. 18. Jayaraman KS. 'Indian ginseng' brings royalties for tribe. Nature 1996. Table I. Currently recognized Panax species Latin binomial and authority Common names Geographical origin P. bipinnatiftdus Seemann pearl ginseng, Himalayan ginseng Burma, China, India, Nepal (syn. P. majorTing; P. pseudoginseng Wallich ssp. himalaicus Hara; P. japonicus C.A. Meyer var. major (Burkill) C.Y.Wu & R.M. Feng; P. pseudoginseng Wallich var. major (Burkill) Li) P. bipinnatiftdus Seemann Tibet, India, Nepal var. angustifolius (Burkill) J. Wen (syn P. sikkimensis Banerjee) P. ginseng C.A. Meyer Asian (Chinese, Korean) ginseng China (Manchuria), Russia (Siberia), Korea P. japonicus C.A. Meyer Japanese (Chikusetsu) ginseng Japan (syn. P. pseudoginsengWallich ssp.japonicus (C.A. Meyer) Hara; P. repens Maximowicz) P. notoginseng F.H . Chen ex Tienchi or Sanchi ginseng China (Yunnan) C.Y. Wu & K.M. Feng, formerly P. notoginseng (Burkill) F.H . Chen (syn. P. pseudoginsengWallich var. notoginseng (Burkill) G. Hoo & C.J. Tseng) P. pseudoginseng Wallich Himalayan or Nepal ginseng, jia renshen China (Xizang), Nepal P. quinquefolius Linnaeus American or North American ginseng North America P. stipuleanatus H.T.Tsai & K.M. Feng bai-tu or ye-sanchi ginseng China (Yunnan), (Treated as part of P. pseudoginseng North Vietnam Wallich var. bipinnatiftdus (Seemann) Li by G. Hoo & C.J.Tseng) P. trifolius Linnaeus dwarf or peanut ginseng North America P. vietnamensis Ha & G rushvitsky Vietnamese ginseng Vietnam P. wangianus Sun Assamese o r Sikkimese ginseng Assam (syn. P. pseudoginsengWallich var. wangianus (Sun) G. Hoo & CJ.Tseng; P. assamicus Banerjee; P. sikkimensis Banerjee) P. zingiberensis C.Y.Wu & K.M. Feng ginger ginseng China (Yunnan) Sources: Wen J, Zimmer EA. Phylogeny and biogeography of Panax L. (the ginseng genus,Araliaceae): Inferences from ITS sequences of nuclear ribosomal DNA. Molecula r Phylogenetics and Evolution 1996;6(2): 167-77. Wen J. Species diversity, nomenclature, phylogeny, biogeography, and classification of the ginseng genus (Panax L.,Araliaceae). In: Punja ZK, editor. Utilization of biotechnological, genetic and cultu ral approaches for North American and Asian ginseng improvement. Proceedings of the Inter national Ginseng Workshop. Vancouver, Canada: Simon Fraser University Press; 200 I. p. 6 7-88. 34 I HerbaiGram 57 2003 www.herbalgram.org \Vhat in the Name of Panax are those other "ginsengs''? 24. Anonymous. Malaysian co. promotes local "gi nseng" overseas. Asia Peninsula, 2 vols. Kuala Lumpur, Malaysia: Ministry of Agriculture Pulse v1a COMTEX. 1999. Documenr ID: FD and Co-operatives; 1966. 19991115660000126. 26. Foster S. I 999 December 27. Personal communication. 25. Burkh ill !H . A Dictionary of the Economic Products of the Malay Table 2. Plants Improperly Sold as "Ginseng" in Commerce Scientific name and Family Sold as Standardize d 1 Other Common Names botanical authority Common Name Adenophora triphylla Campanulaceae ginseng adenophora ladybells (Thunberg ex Murray) A de Candolle Aralia califomica S. Watson Araliaceae California ginseng Califo rnia spikenard elk clover Aralia nudicaulis Linnaeus Araliaceae wild ginseng small spikenard false, wild sarsaparilla Aralia racemosa Linnaeus A raliaceae American spikenard spikenard life-of-man Campanumoea pilosula Campanulaceae bastard ginseng Franchet Caulophyllum thalictroides Berberidaceae blue, blue cohosh blue cohosh (Linnaeus) Michaux yellow ginseng Citrus reticulata Blanco Rutaceae ginseng tangerine Mandarin orange Codonopsis pilosula Campanulaceae bellflower codonopsis dang shen (Franchet) Nannfeldt Eleutherococcus gracilistylus Araliaceae prickly ginseng xi zhu wu jia (WW Smith) S.Y. Hu Eleutherococcus senticosus Araliaceae Si berian gi nseng eleuthero (Ruprecht & Maximowicz) Maximowicz Eurycoma longifolia Jack Simaroubaceae Malaysian ginseng Tongkat Ali (Ali's staff) Glehnia littoralis F. Schmidt Apiaceae ginseng glehnia beach si lver top ex Miquel Gynostemma pentaphyllum Cucurbitaceae Southern, blue gynostemma Oriental Iiana, jiao gu ian (Thunberg) Makino ginseng Hebanthe eriantha A maranthaceae Brazilian ginseng sum a pfaffia (Poiret) Pederson, syn . Pfaffia paniculata (Martius) Kuntze Lepidium meyenii Walpers Brassicaceae Peruvian ginseng maca Oplopanax horridus Araliaceae Pacific ginseng devil's club ( J.E. Smith ) Miquel Polygonum multiflorum Polygonaceae ginseng fo-ti he shou wu Thunberg Pseudostellaria heterophylla Caryophyllaceae prince, lesser pseudostellaria (Miquel) Pax ginseng Rumex hymenosepalus Torrey Polygonaceae wild red desert canaigre ginseng Salvia miltiorrhiza Bu nge Lamiaceae ginseng baby sage danshen Scrophularia spp. Scrophulariaceae ginseng figwort Trichopus zeylanicus Gaertner Dioscoreaceae Indian ginseng jeevani Withania somnifera Solanaceae Indian, ashwagandha winter cherry (Linnaeus) D unal Ayurvedic gi nseng Reference: I. McGuffin M, Kartesz JT, Leung AY, Tucker AO, editors. Herbs of Commerce 2nd ed. Silver Spring (MD):American Herbal Products Association; 2000. www.herbalgram.org 2003 HerbaiGram 57 I 35 erbal medicines made from Echinacea purpurea (L.) risk estimate of less than 1 in 100,000. In the United States, Moench, E. angustifolia DC., E. pallida (Nutt.) Nutt., Canada, Europe and Australia, echinacea is one of the most widely H Asteraceae, are used widely for a number of health used herbal medicines. In the United States, it is estimated that concerns. While prevention and treatment of upper respiratory between 15 percent and 40 percent of American adults take one or 38 40 tract infection (URI) are the most common indications, the repu more herbal medicines in a given year. - Echinacea accounts for tation of echinacea as an "immunosrimulant" is associated with irs as much as 10 percent of the U.S. herbal market, at least in some 41 use for a wide variety of infectious and immunological diseases, market channels (i.e., natural foods). These numbers suggest that from bronchitis' to genital herpes2 to cancer3 to HlV/AIOS.4·5 In 1-4 percent of the general population uses ech i nacea in a given addition, topical echinacea preparations are used to enhance year. Assuming a U.S. population of approximately 200 million wound healing and for other skin conditions.6 adults and self-treating adolescents, one can estimate that between Notwithstanding these many uses, the vast majority of scientific 2 to 8 million Americans use an echinacea product at least once in evidence clusters around immunosrimularion,5.7- I3 and around a given year. With no deaths and few significant adverse effects prevention and treatment of URl.14·17 While existing randomized reponed, the overall risk ratio (number of adverse events I number blinded trials are of only moderate quality, 18-27 results in general exposed) appears quite favorable, especially when compared with have been positive. Systematic reviews have been cautiously opti- the thousands of deaths attributed to widely used over-the-counter 28 32 by Bruce Barrett, M.D., Ph.D. mistic. ' Evidence regarding medicines, such as non-steroidal ami-inflammatory drugs (aspirin, echinacea's ability to prevent ibuprofen, naproxen) and decongestants (e.g., phenyl URl is far from conclusive, but propanolamine, now removed from the market).42-45 evidence from two moderate- Contraindications quality randomized trials suggests a relative risk reduction of 10-15 percent. 24 ·27 For the average adult with three or four colds The German Commission E approved oral preparations of E. per year, this would imply the avoidance of one cold in about 2 1/z purpurea, with a suggested course of no more than 6 weeks. 4G.47 years of echinacea ingestion. Costs and risks of chronic dosing have Chronic progressive immuno-mediated diseases such as tuberculo not been well characterized. sis, rheumatoid arthritis, collagen vascular disease, and multiple Randomized trial evidence for the ability of echinacea used to sclerosis have been listed as conrraindications. 28 These warnings are treat upper respiratory infection is somewhat more positive. theoretical, based on the harm that could result if the immune Reductions in severity18-21 and duration22·26 have been reponed in mediated inflammatory components of these diseases were exacer double-blind placebo-controlled randomized trials. Estimates of bated by echinacea's immunostimulating propenies. Although the degree of symptom severity reduction center on the 25-35 reasonable as precautions, there is no convincing empirical percent range. The two trials claiming reductions in duration have evidence to support or refute these contraindications. significant methodological limitations, reducing confidence in the Data on adverse effects reported 2 to 4 day (20-40 percent) duration reduction bene fits. 22·26 The better trials19· 21 do not report duracion reductions. A Parnham has reviewed "the benefit and risks" of E. purpurea.4B.49 trial we conducted among students at the University of Wisconsin He reports that in Germany, from 1989 to 1995, a total of 13 -Madison found no benefit at all from an unrefined mixture of E. adverse events "possibly associated with the use of Echinacin®" purpurea and E. angustifolia.33 Thus, while the sum total of (pressed juice from fresh E. purpurea herb preserved with 22 randomized trial evidence suggests modest efficacy of echinacea as percenr alcohol; Madaus AG, Cologne, Germany) were reported to an early cold treatment, confidence is tempered by the limited the German federal health authority. Of these, four were judged to amount and quality of existing evidence. be caused by echinacea exposure. All were allergic reactions, with skin rash the predominant finding. During the same time period, Safety several million people in Germany treated themselves with or Following available scientific evidence, echinacea appears to be a received a physician's prescription for an echinacea product. These relatively safe herbal medicine. No significant dose-dependent results would suggest a very low risk of allergic reaction, similar to adverse effects have been noted, no overdoses have been reponed, that for such common substances as wheat, milk, or peanuts. Pam and no contraindications or drug interactions have been proven. ham also reports an unblinded study of 1,231 children (aged 2 to At least 30 randomized trials have been completed.2,23.2G-3D.3 2.34 20 years) who were treated with Echinacin® lozenges. This study None have reported more adverse effects in the treatment versus found a 5 percent overall rate of self-reported adverse effects. Of the control groups. Although there have been repons of allergic the 62 reported problems, unpleasant taste was the most frequent, reactions to echinacea,35 including two cases of anaphylaxis repon with 21 reports (1.7 percent). Nausea, vomiting, sore throat, edly due to echinacea,3G.37 no deaths have been reported. abdominal pain, diarrhea, and difficulty swallowing were reported Perhaps the most convincing rationale for the reasonable safety by 6 or less ( < 0.5 percent) persons each. A number of smaller open of echinacea comes from epidemiological evidence. The ratio of trials and case series have provided some evidence of safety of reported serious adverse effects (less than 100) to the estimated injected echinacea. For example, Roseler and Modi have each number of courses of treatment (more than 10 million) yields a reported treatment series (226 and 120 patients respectively) of patients with post-partum infection who were injected intra- 36 I HerbaiGram 57 2003 www.herbalgram.org ve nously with 0. 1 mL to 1.2 mL of E. purpurea herb juice (Echi Toxicology 49 nacin®), without noting any observed ill effects. Us ing standard toxicological assessment methods, animal ex per In 1998, Mullins reported a case in whi ch a woman with atopy iments have so far fa iled ro demonstra te echinacea-relared rox iciry. (predisposition toward all ergy) ingested a liquid formulati on According ro Mengs, oral doses up ro 15 g/kg and intravenous combining E. purpurea and angustifolia root ex tracts immedi 1 E. doses up to 5 g/kg failed to demonstrate major pathology. ' '·'7 T h1 s ately before ex periencing "burning of the mouth and throat ... group concluded that a lethal dose could not be fo und; hence 36 ti ghtness in the chest, generalized urticari a, and diarrhoea." T he LD50 (dose at which half of ex perimental animals are killed) was incident precipitated a two-hour visit to the emergency depart in calculable. 56 Lenk et aL. have reported that injecti on of varying ment, during which "her symptoms resolved completel y." Subse doses of concentrated echinacea polysaccharide fracti ons in 18 quently, Mullins has reported the res ults of a sys tematic sea rch mi ce did al low calculation of LD50 at 2,500 mg/kg.>H Due to the revealing 5 1 possible cases of echinacea-rel ated all ergy in Australi a, nature of animal studies, small sample sizes, unblinded methods, 26 of which were "s uggesti ve of possible immunoglobulin £-medi rypes of echinacea product (co ncentrated extract) , and modes of ated hypersensitiviry." J7 T he sa me report detail ed fi ve cases in administrati on (injecti on), these res ults are not generali zable to 7 depth as a case se ri es.J While echinacea prevalence-of-use data are human use. N evertheless, these res ults suggest that there is a wide not avail able fo r Australia, use of herbal medicines appears to be therapeuti c window of safety between the typical doses consumed Echinacea purpurea. Photo ©2003 stevenfoster.com 051 similar ro rhar in the United States and Europe. ' T hi s woul d orall y (200 to 2,000 mg in 50-80 kg adults = fro m 2.5 to 40 imply hundreds of thousands of courses of echinacea each year, mg/kg) and the estimated intravenous lethal dose of 2,500 mg/kg. which would in turn suggest that Mullin's data imply relati ve safety Although not conclusive, these res ults are certainly reassuring, rather than ri sk. One other case report has been published. In especiall y when compared with much less favo rable therapeutic 200 I Soon and C rawford reported a single case of erythema windows for common over-the-counter medi cations such as anal nodosum (a n acute inflammatory/immunological skin reaction) gesics and decongestants. which they thought was "temporall y and perhaps causally associ Laboratory analysis of blood, urine, and organ specimens fro m 52 ated with the use of echinacea." Although case reports and case animals treated with echinacea products provid es some additional se ri es may generate hypotheses suggesting associati on, they cannot evidence of safety. Experiments using rats and mice fed up to 8 prove causali ty; hence it is difficult ro draw mea ningful conclu g/kg/ day over several weeks fail ed to demonstrate measurable sions from these reports. C lea rl y, nea rl y any substance may trigger adverse effects. Body weight, orga n weight, histopathological an allergic reacti on in a sensitive individual. All ergies to peni cilli n, analyses of ti ss ue, and blood studies such as complete blood count, sulfa drugs, poll ens, ca ts, horses, and shellfish are common, often li ve r enzymes, creatinine, urea, choles terol, rriglycerides, and blood se ri ous, sometimes fa tal. Risks of all ergy ro echinacea appear to be glucose have been reported as unaffected by oral dosing of echi rel atively small in compari son. Perhaps the bes t es timate of allergic nacea. I6.S7 Geneti c studies looking for chromosome aberration and risk from echinacea comes from a study of I ,032 people patch sister chromatid exchange in bacteri a and cultured animal cell s rested for skin sensitivity ro echinacea, in which two positi ve have similarl y been reported as negati ve for murageniciry.56 A poly 53 inflammatory reactions were found. saccharide fracti on isolated fro m E. purpurea was reported as nega 11 Reproductive risks tive for mutagenicity in a genotoxicity human lymphocyte assay. ' Max imum feas ible oral and intravenous doses of ethanol stabilized As is true with nearly all medicines, safety of echinacea in preg fres h pressed juice of E. purpurea have similarly been reported as nancy has nor been reliably determined. O nly one study has been negati ve for measurable damage in mice or rats.'? Injecti on of E. reported. Gallo and coworkers studied a cohort of 206 women purpurea ex tract into chick embryos fa il ed to cause any detectable who used echinacea during pregnancy. Cases were ri sk-marched changes in development.60 So fa r, screens fo r toxiciry have been 145 with 206 controls and assessed fo r adverse effects in offspring. ' overwhelmingly negative. Similar numbers of stillbirths, chromosome abnormalities, and malformations were found in the two groups. Echinacea species, Summary plant part, dose, and duration of use are nor reported. T he authors While by no means conclusive, the evidence published ro date conclude that "gestational use of echinacea during organogenesis is suggests rhe limited effective ness of echinacea as earl y treatment not associated with an increased ri sk for major malformati ons." fo r rhe common cold. Even more limited evidence may favo r W hile this study suggests a low likelihood of major frequent preventive effi cacy, but the effect size is roo smal l to support adve rse outcomes, it does not es tablish safery. While no evidence chronic use. La rge, confirmarory randomized tri als are sorely of increased ri sk was observed , the study lacked the statisti cal needed. Ev idence for use in other conditions, while suffic ient ro power ro detect potentially important echinacea-associated risks. spur further research, is insuffic ient ro draw clinicall y meaningful Fo r example, a hypotheti cal echinacea-caused serious event (death, concl usions. malformati on) occurring in I in I 00 infa nts could easily have been Safery data are generally positive, bur limited. The lack of missed in this relatively low-powered case control study. adve rse effects reported from several reasonable qualiry clinica l and www.herbalgram .org 2003 HerbaiGram 57 I 37 toxicological investigations is reassuring, but not conclusive. The 4. Berman S, Justi s JC, Tilles JG, Ma CB. Dramatic increase in fact that no major or dose-dependent toxicities have been reported immune mediated HIV killing activity induced by Echinacea angus suggests that echinacea is relatively safe. Nevertheless, it does not tifolia [abstract no. 32309] . International Conference on AIDS 1998; 12:582. prove safery, as rare bur important adverse effects have not been 5. See DM, Broumand N, Sah l L, Tilles JG. In vitro effects of echinacea ruled our. and ginseng on natural killer and antibody-dependent cell cytotoxi It should be remembered that any substance with pharmacolog city in healthy subjects and chronic fatigue syndrome or AIDS ical properties will almost certainly have accompanying toxicities. patients. Immunopharmacology 1997;35:229-35. For instance, echinacea's demonstrated immunostimulating prop 6. Yarnell E. Botanical medicines for dermarologic conditio ns. Alterna erties of macrophage activation and enhanced cytokine production tive & Complementary Therapies 1999; April: I 06-9 . are likely to be associated with immune-related adverse conse 7. Bauer R. Chemistry, analysis and immunological investigations of quences, whether or not these have been demonstrated by current Ech inacea phytopharmaceuticals. In: Wagner H , editor. lmmunomodulatory Agents from Plants. Basel, Boston, Berlin: research. For instance, autoimmune diseases such as rheumatoid Birkhauser Verlag; 1999. p. 41-88. arthritis, lupus erythematosis, or multiple sclerosis could be trig 8. Burger RA, Torres AR, Warren RP, Caldwell VD, Hughes BG. Echi gered or accelerated. Similarly, common problems such as asthma, nacea-induced cyrokine production by human macrophages. fnt J allergic rhinitis, or skin al lergies could be activated or worsened. fmmunopharmaco/1997; 19:371-9. Or perhaps the immune system's natural-and-healthy manner of 9. Eichler F, Kri.iger GRF. Effects of non-specific immunostimulants resisting infectious disease could be interfered with, leading to (Echinacin, isoprinosine, and thymus factors) on the infection and increased incidence or severiry of bacterial o r viral illness. Is there antigen expression in herpesvirus-6 ex posed human lymphoid cells. evidence to back up these speculations? No. Have these possibili In Vivo 1994;8:565-76. ties been ruled out? Not hardly. So, what is the bottom line? People I 0. Elsasser-Beile U, Willenbacher W, Bartsch H H, Gallati H, Schulte Manring J. Cytokine production in leukocyte cultures during ther with al lergic, autoimmune or inAammatory disease (and their apy with Echinacea ex trace. J Clin Lab Ana/ 1996; I 0:441 -5. healthcare advisors) should think very carefully about the possible II . Melchart D , Linde K, Worku F, Sarkady L, Holzmann M, Jurcic K benefits and risks before dosing with this herbal medicine. For et al. Results of five randomized studies on the immunomodulatory children and pregnant women, where there are no studies report activity of preparations of Echinacea. J Altern Complement Med ing benefit, caution is recommended. But for the average healthy 1995; I: 145-60. adult in the beginning of a common cold, echinacea seems like a 12. Srotzem CD, Hungerland U, Mengs U. Influence of Echinacea reasonable choice, certainly as good as antihistamines, deconges purpurea on the phagocytosis of human granolocytes. Medical Science tants, zinc, or vitamin C, al l of which have a modicum of evidence Research 1992;20:7 19-20. 13. Willigmann I, Egert D, Bodinet C, Beuscher N. Chemical and to support their use, and certainly better than antibiotics, which immunological properties of the immunomodularory active clearly do not work. Of course, this advice may change as more compounds from the roots of different Echinacea species. Planta evidence becomes available. _At M ed 1993;59:671-3. Bruce Barrett, M .D., Ph.D., is Assistant Professor in the Depart 14. Abdu llah T. A strategic call to utilize Echinacea-garl ic in flu -cold ment of Family Medicine at the University of Wisconsin- Madison season. }AMA 2000;92:48-5 1. Medical School. He is supported in part by a career development grant 15. Bone K. Ech in acea: What makes it work? Alternative Medicine from the National Center for Complementary and Alternative Medi Review 1997;2:87-9. cine at the National Institutes of Health. Dr. Barrett's background 16. Gunning K. Echinacea in the treatment and prevention of upper respiratory tract infections. WJM 1999; 17 1:198-200. includes a doctorate in Anthropology (ethnomedicine and health care 17. Hobbs C. Echinacea: A li terarure rev iew. HerbalGram (Special systems in Nicaragua) and a johns Hopkins feLLowship in interna Supplement) 1994;30:33-47. tional health (based in Guatemala). He is a member ofthe American 18. Braunig B, Dorn M, Limburg E, Knick E. Echinaceae purpureae Botanical Council Advisory Board. He has published several articles radix: zur starkung der korpereigenen abwehr bei grippalen infekten regarding the ethnobotany and contemporary use ofherbal medicines. [Strengthening of the endogenous resistence ro influenza! infections. Translation by Ralph McElroy Co., Austin, TX]. Zeitschrift for References Phytotherapie 1992;13:7- 13. I. Baetgen D. Behandlung der akuten bronchitis im kindesalter. Prax is 19. Brinkeborn RM, Shah DV, Degenring FH. Echinaforce® and other studie mit einem immunstimulans aus Echinacea purpurea [Treat Echinacea fresh plant preparations in the treatment of the common ment of acute bronchitis in child ren. A study of an immunostimula cold. Phytomedicine 1999;6: 1-6. rory agent from Echinacea purpurea in a primary care se ning. Trans 20. Dorn M, Knick E, Lewith G. Pl acebo-controlled double-blin d study lator unknown.]. Therapiewoche Piidiatrie 1988; I :65-70. of Echinacea pal/ida radix in upper respiratory tract infection. 2. Vonau B, Chard S, Mandalia S, Wilkinson D, Barton SE. Does the Complement Ther Med 1997;5:40-2. extract of the plant Echinacea purpurea influence the clinical co urse 21. Henneicke-von Zepelin HH, Hentschel C, Schnitker J, Kohnen R, of recurrent genital herpes) lnt J STD AIDS 200 I; 12:154-8. Kohler G, Wi.istenberg P. Efficacy and safety of a fixed combination 3. Lersch C, Zeuner M, Bauer A, Siemens M, Hart R, Drescher M et phyromedicine in the treatment of the common cold (Acute viral al. Nonspecific immunomodulation with low doses of cyclophos respiratory tract infection): Results of a randomized, double bli nd, phamide (LDCY), thymostimulin, and Echinacea purpurea extracts placebo controlled, multicentre study. Curr Med Res Opin (Echinacin ) in patients with far advanced colorectal cancers. Cancer 1999; 15:214-27. Invest 1992; I 0:343-8. 22. Hoheisel 0, Sa ndberg M, Bertram S, Bulitta M, Schafer M. Echina ga rd treatment shortens the co urse of the common cold: A double- 38 I HerbaiG ram 57 2003 www.herbalgram.org blind, placebo-controlled clinical trial. European Journal of Clinical survey of 1500 households. Research 1997;9:261-8. 4 1. Brevoort P. The Booming U.S. Botanical Marker: A New Overview. 23. Lindenmuth GF, Lindenmuth EB. T he efficacy of Echinacea HerbalGmm 1998;44:33-46. compound herbal tea preparation on the severity and duration of 42. Bares OW, C ullen OJ, Laird , Peterse n LA, Small SO, Servi D et upper respiratory and Au symptoms: A randomized , double- blind rd. Incidence of adverse drug eve nrs and potential adverse drug pl acebo-controlled study. j Altern Complement Med 2000;6:327-34. evenrs. Implications for preve nrion. ADE Prevenrion Study Group. 24. Melchart 0 , Walther E, Linde K, Brandmaier R, Lersch C. Echi JAMA 1995;274:29-34. nacea root extracts for the prevention of upper res pirarory tract infec 43. Brewer T, Colditz GA. Postmarketing surveillance and adverse drug tions: A double-blind, placebo-controlled randomized trial. Arch reactions. JAMA 1999;28 1:824-9 . Pam Med 1998;7:541-5. 44. Cetaruk EW, Aa ron C K. H az:~ rd s of nonprescription medica tions. 25. Scagli one F, Lund B. Efficacy in rhe rreatmenr of the co mmon cold Emerg Med Clin North Am 1994; 12:483-5 10. of a preparation containing an Echinacea ex tract. lnt J lmmunophar 45. G riffin MR, Scheiman JM. Prospects for changin g the burden of macol 1995; II: 163-6. nonsteroidal anti-inflammatory drug toxicity. American journal of 26. Schulten B, Bulitta M , Ballering- Bri.ihl B, Koster U, Schafer M . Effi Medicine 200 I; II 0:33S-7S. cacy of Echinacea purpurea in parienrs wirh a co mmon cold: A 46. Blumenthal M , Busse WR, Goldberg A, Gruenwald J, Hall T, placebo-controlled, randomised, do uble-blind clinical trial. Ri ggins CW, Rister, RS , editors. Kl ein S, Rister RS , translators. The Arzneimitte/forschung 200 I ;5 1 :563-8. Complete German Commission E Monographs: Therapeutic Guide to Echinacea purpurea. Photo ©2003 stevenfoster.com 27. Turner RB , Riker OK, Gangemi J D. Ineffective ness of Echinacea for Herbal Medicines. Austin, TX: American Botanical Council , Bosron, prevention of ex perimental rhinovirus colds. Antimicrob Agents MA: Integrative Medicine Communica tions; 1998. Chemother 2000;44: 1708-9. 47. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: 28. Blumenrhal M , Hall T, Goldberg A, Kunz T, Dinda K, Brinckmann Expanded Commission £Monographs. Austin, TX: Ameri can Botani J et al., editors. Echinacea: Echinacea purpurea (L.) Moench, £.pall ca l Council ; 2000. ida (Nutt.) Nutt, £. angustifolia D.C. [Family Asteraceae]. In: The 48. Parnham MJ. Benefit-ri sk assess ment of rhe squeezed sa p of rhe ABC Clinical Guide to Herbs. Austin TX: American Botanical Coun purple coneflower (Echinacea purpurea) for long-term oral immunos cil , [in press]. timulation. Phytomedicine 1996;3:95- 102. 29. Barrett B, Vohmann M , Calabrese C. Echinacea fo r upper respirarory 49. Parnham MJ. Benefi t and risks of rhe squeezed sa p of the purple infection: Evidence-based clinical review. J Pam Pract 1999;48:628- coneflower (Echinacea purpurea) for long-term oral immunosrimu 35. lanr therapy. In Wagner H , editor. lmmunomodulatory Agents from 30. Barrett B. Echinacea for upper respiratory infection: An assessment Plants, pp I 19-36. Basel, Bosron, Berlin: Birkhause r Verl ag; 1999. of randomized trials. Health Notes: Review of Complementary and 50. Drew AK, Mye rs SP. Safety iss ues in herbal medicine: Implications Integrative Medicine 2000;7:2 11 -8. for rhe health professions. Med j Aust 1997; 166:538-4 1. 3 1. Giles JT, Palat CT, C hien SH , C hang ZG, Kennedy DT. Evaluation 51. MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of of Echinacea for treatment of rh e common cold . Pharmacotherapy alternative medicine in Australia. The Lancet 1996;347:569-73. 2000;20:690-7. 52. Soon SL, C rawford Rl . Recurrent erythema nodosum associated 32. Melchart D, Linde K, Fischer P, Kaes mayr J. Echinacea for prevent wirh Echinacea herbal therapy. JAm Acad Dermatol200 I ;44:298-9. ing and treating rhe common cold . 1-23. 2000. Update Software. 53. De Smer PAGM, Kell er K, H ansel R, C handler RF. Adverse Effects of Cochrane Library, Iss ue 4. Herbal Drugs, Vo lume 3. Berlin , Heidelberg & New York: Spri nger 33. Barrett Bl~ Brown RL, Locken K, Maberry R, Bobula JA, D 'Aiessio Verlag; 1997. D . Treatment of the common cold with unrefined echinacea: A 54. Gallo M, Sarkar M, Au W, Piem.ak K, Comas B, Smith M et al. randomized, double-blind, placebo-conrrolled trial. Ann lnt Med Pregnancy outcome following gestational ex posure ro Echinacea. 2002 December 17: 137( 12):939-46. Arch Intern Med 2000; 160:3 14 1-3. 34. Melchart 0, Linde K, Worku F, Bauer R, Wagner H . lmmunomod 55. Gallo M, Koren G. Can herbal products be used sa fely during preg ul ation with Echinacea: a sys temati c rev iew of controlled trials. nancy) Focus on echinacea. Can Pam Physician 200 I ;47: 1727-8. Phytomedicine 1994; I :245-54. 56. Mengs U, C lare C B, Poiley JA. Tox icity of t.chinacea purpurea. 35. Bi elory L. Adverse reactions to complementary and alternative medi Arzneimitte/forschung 1991 ;4 1: I 076-8 1. cine: ragweed 's cousin, the coneflower (echinacea), is "a problem 57. Mengs U, Leusch ner J, Marshall RR. Tox icity studies wirh Echinacin more than a sneeze." Ann Allergy Asthma lmmunol2002;88:7-9. [abstract]. Third In ternatio nal Conference on Phyromedicin e, 36. Mullins RJ . Echinacea-associated anaphylax is. Med j Aust Munich, Germany, 2000 O crober I 1- 13 . Phytomedicine 1998; 168: 170- 1 . 2000;Supplement 11 ;7:32. 37. Mullins RJ , Heddle R. Adverse reactions associated with echinacea: 58. Lenk W. Akute toxizitat vo n ve rschi edenen polysacchariden Echi T he Australi an ex peri ence. Ann Allergy Asthma lmmunol nacerz purpurea an der maus. [Acure roxicity of va rious polysaccha 2002;88:42-5 1. rides from Echinacea purpurea in the mouse. Translated by Foit BV, 38. As tin JA. Why patients use alternative medici ne: Results of a natio nal Santa C ruz, CA]. Zeitschrift for Phytotherapie 1989; I 0:49-5 1. study. JAMA 1998;279: 1548-53. 59. Schimmer 0, Erlangen, Abel G, Nurnberg, Behninger C. Investiga 39. Eisenberg OM, D avis RB , Ettner SL, Appel S, Wilkey S, Van tion of rh e genotoxic potency of a neutral polysaccharide from Echi Rompay M et al. Trends in alternative medicine use in the United nacea tissue cultures in human lymphocyte cultures. Zeitschri.ft for States, 1990- 1997. ]AMA 1998;280: 1569-75. Phytotherapie 1989; I 0:39-42. 40. Landmark Healthcare. T he Landmark report on public perceptions 60. Nuckols JT, C hopin SF. Echinacea purpurea injection did nor effect of alternative care. 1998 nationwide study of alternative care. 1998. early development in chick embryos. Poster Session 2000;48: I 13A. Sacramento CA, Landmark H ealthcare, Inc. Random telephone www.herbalgram.org 2003 HerbalGram 57 I 39 Aromatic Herbal Baths of the Ancients by Farid Alakbarov, Ph.D. rom ancient times through the Middle Ages, differ However, volatile oils are not the only agents working ent nations of the Mediterranean and Near East in an aromatic bath. Fragrant plants contain numerous Fused aromatic herbal baths widely for medical other constituents (tannins, flavonoids, alkaloids, etc.) purposes. Over time this practice, which began in that are also therapeutic in an herbal bath. The infusion Ancient Egypt and Babylon and was further developed of a whole fragrant herb is often considered to be more by famous Greek scholars and practitioners, spread effective than its pure volatile oil.4 throughout Southern Europe and the Near East and, Despite the number of modern works on phytother later, influenced medical practices in Western Europe. apy,5 compared with the ancient medical manuscripts, Herbal baths, which were highly valued by the they contain limited information about aromatic baths. ancients, are not completely forgotten today. Modern Many ancient recipes have been forgotten. To revive science proves that bathing can relieve muscle tension, them, one must refer to the ancient books on medicine dilate blood vessels, and slow the heart rate. 1 Herbs can and pharmacy. These sources contain numerous recom contribute to these benefits. Bathing with infusions of mendations that might be of interest to modern physi fragrant herbs is used traditionally to treat many cians and could enrich modern herbal medicine. diseases, may eliminate physical and mental tiredness, The author of this article is engaged in the study of the and is beneficial ancient practice for the skin and of phytotherapy hair. 2 in the Near East. Since the late For these 1960s, owing to purposes, infor the widespread mation from use of manuscripts phytotherapy in dating from the United 9th - 18th States and centuries C.E. Europe, herbal and written in baths have Latin, Greek, become even Arabic, Azerbai more popular. jani, Turkish, and Many unique Persian has been methods of analyzed. All application of these sources are herbs in our kept at the Insti daily life have tute of Manu been developed, scripts of the and today a Azerbaijan Acad number of Queen Shirin bathing in a spring. This illustration is from Khamsa (Quintuple), the manu emy of Sciences medicin a l script by the Azerbaijani poet Nizami Ganjavi (1 141 - 1203). Pa inted in 1648 in Bukhara, in Baku. As a Uzbekistan. preparations result, so me and cosmetics forgotten ancient are produced with herbs and sold throughout the recipes have been deciphered. 6 Some of these medieval world. Soaps, shampoos, and shower gels containing and earlier recommendations are cited and analyzed in various herbs and other plant-derived aromatic this article. This author believes that they may enrich substances are now widely available for bathing or hand modern phytotherapy, once they have been experimen washing.3 tally and clinically tested. 40 I HerbaiGram 57 2003 www.herbalgram.org History After the collapse of the Roman Empire in the 5th century C.E., Western Europe plunged into the Middle The ea~liest written· information about therapy by Ages, a dark era of ignorance (ci rca 400- 1450 C. E.), which bathmg w1th decoctions of aromatic herbs is contained in in some countries continued up to the Renaissance and t~e Indian Yed_as dating back to 1500 B.C. E. Ancient Egyp Reformation (circa 1450-1700 C. E.) . However, during the tians, Babylomans, Assyrians, and Hebrews widely applied Renaissa nce and Reformation, the C hurch forced the this practice for hygienic and medicinal purposes. For demise of saunas and nearly rendered the European bath example, Cleopatra, Queen of Egypt (69-30 B.C.E.) , house ex tinct. Only Finnish, Russian, and Scandinavian bathed with rose (Rosa spp., Rosaceae) petals.? After peop_les continued their traditions of herbal bathing. In bathing, Egyptians would apply perfumes and ointments Russ 1a, people bathed in special wooden houses (bania) from cinnamon (Cinnamomum verum ]. Pres!, Lauraceae), with hot water and steam. Before the 18th ce ntury C. E. , pe~~ermint C'!fentha x piperita L. , Lamiaceae), white lily these bania were common, and men and women bathed (Lzlzum candzdum L., Liliaceae), sweet marjoram (Orig together. Russians applied a kind of herbal therapy in their anum majorana L., Lamiaceae), Indian frankincense bathhouses : they vigorously thrashed each other with (Boswellia serrata Roxb. , Burseraceae), and oils derived switches of green birch twigs (so-called Birch Broom). It from almond (Prunus dulcis (Mill.) D.A. Webb., syn. P. amygdalus Barsch., Rosaceae) , castor (Ricinus communis L., Euphorbiaceae), olive (Olea europaea L., Oleaceae), and sesame (Sesamum indicum L., Pedaliaceae) J The Greek physician Hippocrates (circa 460-377 B.C.E.), known as the Father of Medicine, learned about the healing properties of aromatic baths from the ancient E~ptians. He subsequently developed teachings about usmg water as a form of treatment, which he called hydropathy. Medicinal bathing also was called thalassother apy or hydrotherapy (water cure). The name thalassotherapy may come from ancient Greek thalassa (small sea) or from the Greek philosopher Thales (circa 636- 546 B.C. E.), who believed that the phys ical world derives from a single underlying substance: water.1 This treatment method was later adopted by Roman physicians and gradually spread throughout the Mediter ranean. The bathhouses (thermae) of ancient Rome became famous, owing to their fragrant decoctions and balmy oint ments. Such scholars as Dioscorides (lsr century C.E.) and Galen (circa 130-200 C. E.) recommended aromatic baths for urological and genital disorders, as well as for tumors, wounds, colds, bad mood, and fatigue.s Galen treated patients for fever in the famous Hadrian baths. Some pub_lic thermae in Rome were huge, magnificent buildings havmg separate rooms with hot, warm, or cold water, and special sections for massage, sports, and physical exercises. The Caracalla Baths in Rome were especially impress ive and famous during the 3rd century C.E. People not only bathed there, bur also were treated with water, massage, This mural of a Southern European apothecary was painted in late 15th century and aromatic herbs, they also relaxed, visited with friends, Italy. The illustration is from the book Ancient Medicine; the inscriptions on the wall and entertained. were made later and are not related to the mural itself. According to Greek historians, native inhabitants of C?entral, Northern, and Wes tern Europe also used primi was believed that such "birching" in a bath improves circu tive herbal baths. For example, the Greek historian lation and rejuvenates an organism. 1o Birch leaves were also Herodotus (circa 484-425 B.C.E.) mentions that the placed over the hot rocks to ex pel cleansing vapors. Scythians, a nomadic tribe of the Ukraine region, used The Finnish bath (sauna) resembled the traditional Russ hempseed to medicate a vapor bath: "The Scythians rake ian bath, but its princi pal therapeutic effect was associated some of this hempseed, and, creeping under the felt cover not with hot water, but with steam. An old Finnish proverb ings, throw it upon the red-hot stones; immediately it says, "The sauna is the poor man's apothecary."BCompared smokes, and gives off such a vapour as no Grecian va pour to the ancient Greeks, the peoples of Northern and Eastern bath can exceed."? Europe used fewer herbs in bathhouses and their bathing www.herbalgram.org 2003 HerbaiGram 57 I 41 attribute great healing properties to bathing. An 11th century Iranian writer, Keykavus Ziyari , wrote, "Since architects began to raise buildings, they created nothing better than a bathhouse. " 12 In ord er to maintain health, it was recommended that a person visit a bathhouse at least two or three times each week. Bathhouses served as both beaury parl ors and health clinics .12 Medieval Middle Eastern bathhouses usually offered se rvices such as bathing and massage with the application of aromati c oil s. Many large public bathhouses had a staff of masse urs for this purpose, because it was believed that massage all eviates physical and mental tiredness, and 14 improves circulation.13· Aromatic oils were also used to treat vari ous diseases. For example, thyme ointment (Thymus spp., Lamiaceae) was applied for rheumatism, and an ointment with henna (Lawsonia inermis L., Lythraceae) or onion (Allium cepa L. , Liliaceae & Alli aceae) was used for herpes. 13, l5 T he staff of many bath houses included a barber who cut hair and shaved the customers, and then applied henna (Lawsonia inermis L. , Lythraceae), dyer's woad (Isatis tinctoriaL., Brassicaceae) , or other dyes to their hair. 13 After a bath and a massage, visitors to the bathhouse could res t and rel ax in a special room where they would drink coffee or tea with fragrant herbs that included peppermint, thyme, sweet marj oram, rose petals, cardamom (Elettaria cardamomum (L.) Maron var. cardamomum, Z ingiberaceae) or cloves (Syzygium aromaticum (L.) Merr. & L. M. Perry, Myrtaceae ).16 In Azerbaij an, customers could al so order sweets, dinner, or a pipe. Stays in the bathhouse were so pleasant that some people would spend all their free time there; some eve n slept there. As a rule, after a visit to the bathhouse, people felt rejuvenated, attractive, healthy, strong, and energeti c. 12 In this book ill ustration from 1320, a lecturer reads from a book labeled "Avicenum; the Latin form of Ibn Sina's name, while an assistant prepa res a compound with T he medieval Middle Eastern bathhouse was a very mortar and pestle. The image is from a handwritten medieva l We stern European beautiful architectural object, usually a stone building book, and is produced from Ancient Medicine. with arches, domes, and beautiful gates. In Azerbaijan, the inner part of the public bathhouse consisted of the traditions were much simpler. entrance hall and one or several large bathing halls with During the Middle Ages, the Greco-Roman culture of pools. T here was al so a cloakroom and rooms for res t. hyg iene, bathing, and treatment by aromatic plants Bathhouses were heated by hot steam circulated in pipes survived and continued to develop in the Byzantine under fl oor and wal ls. Several large medieval bathhouses Empire, Middle East, and Central Asia, where Greek are still preserved in Baku, including the Haji Gayib Bath medical traditions were influenced by Middle Eastern and house (built during the 15th century C. E.) and the Gasim Indian phytomedicine. Bath pavilions were a common and bey Bathhouse (built during the 17th century C.E.) , which well -attended fea ture of hospitals in Constantinople. After now houses a museum of medieval pharmacy. In medieval the 7th century C. E., aromati c baths were added to the times, the bathhouses would serve men one day, and armamentarium of Muslim phys icians, including the great women the next. Ibn Sina (also known as Av icenna, 980- 1037 C. E.), who T he Near Eastern authors of the Middle Ages suggest be lieved that bathing in a decoction of dill (A nethum grave numerous plants to use in one's bath, including grape olens L., Apiaceae) is good fo r intes tinal colic and stops leaves ( Vitis vinifera L., Vitaceae) , chamomile (Matricaria co nges tio n of sperm, while a bath with leaves of bay recutita L. , As teraceae), pomegranate (Punica granatum L., (Laurus nobilis L., Lauraceae) is effective against urinary Lythraceae & Punicaceae), bas il (Ocimum basilicum L., diseases. 11 Lamiaceae), anise (Pimpinella anisum L., Apiaceae) , vi olet During the Middle Ages, a cult of bathing was formed in (Viola sororia Willd., Violaceae), almond oil, garlic (Allium Persia, Turkey, and the Caucasus. Contemporary sources sativum L. , Liliaceae & Alliaceae) , and barley (Hordeum 42 I HerbaiGram 57 2003 www.herbalgram.org ======~ ======vulgare L., Poaceae). Ancient manuscripts provide evidence seed, chamomile flower, ye ll ow sweerclover or yellow that during the 9th-14th centuries the aromatic oils of melilot herb (Melilotus officina/is {L.) Pall., Fabaceae), about 50 species of herbs and flowers were used for treat mallow leaves (Malva neglecta Wallr., Malvaceae), cabbage ment through bathing and external application. Medieval leaves (Brassica oleracea L. var. capitata L., Brassicaceae), sources provide information about methods of preparation beetroot (Beta spp., Chenopodiaceae), and fl ax seed and the curative properties of these baths. 16 (Linum usitatissimum L., Linaceae). These were boiled and Near Eastern bathhouses used fragrant substances in added to rhe bathtub. IS several ways, including: I. Aromatic decoctions or infusions were added to the Poor urination water in a bath. For example, Mu'min (d. 1697) wrote Garlic (Allium sativum L., Liliaceae & Alliaceae). that bathing in a decoction of pine needles (Pinus spp., According to Ibn Sina, "Sitting in the decoction of stems Pinaceae) is good against diseases of the uterus and and leaves of garlic causes a diuretic effect .... " 11 Garli c rectum. 17 baths may have a therapeutic value since this plant has anti 2. Ointments containing aromatic herbal oils were spasmodic properties and substantial effects against bacte applied to patients' bodies after or before bathing. For ria, fungi , viruses, and even worms.4•19 In veterinary medi example, it was recommended to massage a patient's cine, garlic is often added to otitic herbal mixtures for irs body with the ointment of pine pitch, euphorbium antibiotic properties.20 Since boiling garlic inactivates some juice (from Euphorbia spp., Euphorbiaceae) and of its beneficial effects, garlic baths may be less effective for guggul {resin of Commiphora wightii (Arn.) Bhandari, inflammatory diseases than an ointment of fresh chopped Burseraceae), which was considered a good cure for garlic. 2 1 stones in the bladder if applied after bathing with a special decoction. 13 Some caution must be taken when using euphorbium juice, which is caustic.5 3. Usually, fragrant fruits or perfumes were placed near a bathing person. It was believed that aromatic substances strengthen the heart and have a sedative effect. "[Hot] water in a bath should not cover the patient's breast and heart," wrote Ibn Sina. 13 It was recommended to bathe as long as the skin continues to redden and swell. However, one was advised to stop bathing after the skin began to pale. 14 According to rhe folk medicine of Azerbaijan, after a hot bath or nap, one was advised to apply rose, narciss us (Narcissus spp., Liliaceae & Amaryllidaceae), or violet aromatic oil to the face and body. Women especially liked these oils since they make the skin render and silky when applied after bathing. Reproductive, Urinary and Intestinal Disorders In addition to the ancient manuscripts, cultural memory has retained the secrets of ancient therapy from aromatic plants. The author has collected some of these recommen dations from native residents in various districts in Azer baijan and listed them below. Such information is indi cated by the words "Pers. comm." {personal communica tion). Data on when, where, how, and from whom this information was collected are shown as well. Cancer of the uterus The herbs mentioned below were recommended not to treat cancer itself, but as analges ic remedies. For example, the 15th century Iranian author Mansur bin Mohammed wrote in his book Kifoyayi-Mansuri (Sufficient from Nine Greek physicians are named and portrayed on one of the opening pages of Mansur), "As to the cancer, it is a very dangerous disease an Arabic medica l ma nuscript written in the region of Mosul, in present-day Iraq, between 1220 and 1250. The text,Antidotorium, outlines the thought of the great and scarcely may be cured." 18 Mansur recommends an analgesic bath containing dill second-century Greek physician Galen on antidotes against poisons. ~======&~======~ www.herbalgram.org 2003 HerbaiGram 57 I 43 ~~~~~~===== ~ ~======~ Stones in the bladder and kidneys bathe in a decoction of seeds and leaves of peppermint.24 In order to crush and remove stones from the urinary The menthol in peppermint oil has a local vaso-constrictive bladder, Ibn Sina recommends bathing with an herbal effect and can relieve hemorrhage. 4 mixture containing the following ingrediems: chaste uee Skin Diseases and Allergies berry ( Vitex agnus-castus L., Lami- aceae), maidenhair fern herb Since antiquity, the unguents, (Adiantum capiLlus-veneris L., powders, and baths with decoc Adiantaceae), mugwort herb tions and infusions from aromatic (Artemisia vulgaris L., Asteraceae), plants were widely used to treat rose petals (Rosa spp., Rosaceae), skin diseases and allergies. and other herbs with astringent Modern research now shows that properries. 13 Supposedly, the the chemical composition of astringent remedies may be pome many aromatic plants contains granate skin, barberry fruits ethereal oils with anti-inflamma (Berberis vulgaris L., Berberi tory, anti-microbial, and analgesic daceae), or cornelian cherries properries.4 (Cornus mas L., Cornaceae). Allergic itch of the skin Nowadays, in Azerbaijan, these herbs are widely used in the These remedies were used not to cure the allergy itself, but only preparation of herbal baths. An image of a pine from Khamsa (Quintuple), the man u script by the Azerbaijani poet Nizami Ganjavi to relieve the allergic itch. Tumors and (11 41-1203). Painted in 1648 in Bukhara, Uzbekistan. Pine Numerous representatives of two pains in the uterus baths were used to treat infectious skin diseases. genera of conifers were applied Anti-spasmodic, analgesic, and for these purposes. antiseptic herbs were applied for uterine dysfunction. To Juniper (Juniperus spp., Cupressaceae). Yusif Khoyi in dilate blood vessels and release muscle tension, it was 1311 C. E. prescribed bathing with juniper cones to ease 2 recommended to use hot water. 15 allergic itch of the skin. 3 According to Azerbaijani folk Chaste tree (Vitex agnus-castus L. , Verbenaceae). Accord medicine, juniper baths are effective against allergic itch of ing to Ibn Sina, "Sitting in decoction of chaste tree seed is the skin. It was recommended to carefully boil 50 juniper effective against pains and tumors in the uterus." 11 The cones in 8 glasses (approximately 2 liters) of water and add anonymous author of Tibbname (Book ofMedicine), which the decoction to the bathtub (Pers. comm. M. Akhundov, was compiled in Azerbaijan in 1712, also writes that chaste conversation, 1989 December in Baku, Azerbaijan) . These tree seed has analgesic properties. 22 In his book jamiye properties of the juniper baths may depend on counter-irri- Baghdadi (Baghdad's tant and anti-inflam- Collection, 1311 C.E.), matory activities of the medieval Azerbai the juniper oil. 25 jani author Yusif bin Pine needle (Pinus Ismail Khoyi writes spp., Pinaceae). about anti-inflamma Mu'min recom- tory properties of mended bathing in a chaste tree baths. 23 decoction of pine needles to cure allergic Uterine itch. 17 In Azerbaijan, hemorrhage baths prepared with a Peppermint I 0 percent decoction (Mentha x piperita L., of needles, cones, and Lamiaceae). The 18th branches of pine are century C.£. Azerbai considered a cure for pnt author Abul allergic itch of the hasan Maragayi skin. Owing to writes in his treatise counter-irritant and Mualijati-munfarida anti-in flam rna tory (Treatment with properties of the pine Simple Remedies) that needle baths, they a woman with uterine may relieve allergic 2 hemorrhage should In the medieva l periods, flowers of fruit trees also were used medicall y. Detail from a itch. 5 book miniature by Sul tan Muhammed Tabrizi, 16th CE (Tabriz city, Iran ian Aze rbaijan). 44 I HerbaiGram 57 2003 www.herbalgram.org ======~ ~ ======~ Irritation and inflammation of the skin healers in Azerbaijan use mugwort to prepare baths for Chamomile (Matricaria recutita L., Asteraceae). The infectious diseases of the skin (Pers. comm. K. Baghirov, conversation, 1992 May in Barda, Azerbaijan). Such appli 18th century C.E. manuscript, Tibbname, recommends bathing with a decoction of chamomile flowers to ease cations of mugwort are typical also to Bulgarian folk medi pimples and inflammation of the skin.22 According to cine, where bathing in a mugwort decoction is recom Azerbaijani folk medicine, bathing in a chamomile decoc mended to treat pyoderma (bacterial skin infection), 4 tion soothes skin irritation and inflamma- infected wounds of the skin, etc. The volatile oil contained tion. It is recommended to add a handful in mugwort baths has antimicrobial prop of dried chamomile flowers to five glasses erties. At a concentration of 1:10, it (approximately l liter) of boiling water depresses development of the bacteria and infuse for half an hour. Then, filter Pseudomonas aeruginosa, Klebsiella pneu the infusion through a cloth or tea strainer moniae, and S. aureus.3 However, the and add to the bath water. The optimal volatile oil did not show any antimycotic temperature of the water must be similar effect against the yeast, Candida albicans.29 to the temperature of the human body According to the data ofLambrev eta!., an (Pers. comm. A. Muradov, conversation, alcoholic infusion of mugwort leaves 1988 July, in Baku, Azerbaijan). shows antibacterial effects against Shigella The chief constituent of chamomile has sonnei and BaciLLus subtilis.3° To treat tired anti-inflammatory properties, owing feet, Gardner recommends a soothing primarily to such compounds as chamazu An image of cypress from Khamsa footbath with mugwort, comfrey lene and (-)-alpha- bisaboloP Even (Quintuple), the manuscript by the (Symphytum spp., Boraginaceae) and mint Azerbaijani poet Nizami Ganjavi though a decoction of the plant contains (Mentha spp., Lamiaceae).J' The German (1141 - 1203).Painted in 1648 in only about 10-15 percent of the volatile Commission E warns that some sensitive Bukhara, Uzbekistan. Ba ths with subjects may have an allergic reaction to oil present in the plant material, it has cypress cones and leaves were mugwort.32 very strong anti-inflammatory properties. 5 widely used to treat skin, urological, Juniper (Juniperus spp., Cupressaceae). and nervous diseases. Oregano (Origanum vulgare L. Lami aceae). The Tibbname discusses antiseptic T he 15th C.E. author Mansur recom- mended applying a juniper decoction externally to treat and anti-inflammatory properties of infectious wounds of the skin. 18 In Azerbaijani folk medi oregano decoctions and juice applied externally or used as cine, juniper baths are used to treat rash, inflammation and a local bathY According to Azerbaijan folk medicine, itch of the skin (Pers. comm. A. Muradov, conversation, bathing in an infusion or decoction of oregano is good fo r 1989 July, in Baku, Azerbaijan). Baths and unguents many skin diseases. This treatment was prescribed for containing the infused oil of Zeravshan juniper (j. polycar pimples and scrophuloderma (Pers. comm. D. Turabov, pos K. Koch., syn. I seravschanica Kom.) have shown a conversation, 1988 July, Shaki, Azerbaijan). Water infu bacteriostatic effect in pathogenic microorganisms. sions of this herb have shown antiviral effect in vitro.• An Further, these baths promote regeneration and granulation aromatic bath with oregano oil is prescribed to ease various 4 of damaged tissues. 26 In Cuba, juniper decoctions are used pains and colic. for patients affected by skin and urinary infectionsY Pine needle (Pinus spp., Pinaceae). According to Juniper tar is a principal constituent of Vishnevski Mu'min, pine needle decoctions show ami-inflammatory 1 Unguentum®, which is used in Russia for wounds. effects when used externally in a bath. 7 Azerbaijan folk Martinez et a!. have medicine recommends baths of needles, cones, and reported on the branches of pine activity of I for rash, pimples, barbadensis L. var. and inflammation lucayana (Britt.) of the skin. The oil R.P. Adams bis of the endemic against Staphylococ eldar pme (P cus aureus. 28 brutia Ten. var. Mugwort eldarica (Medw.) (Artemisia vulgaris Silba) is considered L., Asteraceae). especially effective. Tibbname reported T his pine grows in antiseptic properties the mountains of of mugwort decoc the Major Cauca tions when applied sus and is culti externally. 22 Folk vated throughout A picture of horse-tail (Equisetum arvense) from an 18th century Mongolian·Tibet medical the Azerbaijan manuscript, Sultara, by an unknonwn artist. www.herbalgram.org 2003 HerbaiGram 57 I 45 Republic.25 Anti-inflammarory properties are associated septic and healing properries.23 According ro Azerbaijani with pine oil, which has strong antiseptic and diuretic folk medicine, cinnamon baths are good for external properties, promotes granulation of wounds, and is used as tumors {Pers. comm. Y. Garayev, conversation, 1990 July disinfectant and deodoranr.2 1 Ritch-Krc eta!. have revealed in Shamakhi, Azerbaijan). In many eastern countries, that pitch preparations of P contorta Douglas ex Loudon cinnamon is used externally for boils and abscesses.35 The have antimicrobial activity against known human pharmacological effects of cinnamon baths depend on anti pathogens: Escherichia coli, S. septic properties of this planr.36 aureus, P aeruginosa, C. albicans, White lily (Lilium candidum L., and Aspergillus fomigatus.33 Phar Liliaceae). Medieval medical macological effects of pine baths manuscripts of T iber recom may depend on oils and mended lily baths ro cure wounds terpenoids, many of which have and ulcers of the bodyY Both antibiotic properties. 5 infusions and decoctions of the bulb promote healing of experi Stings of Poisonous mentally induced wounds in rats.3 Animals The infusion of the bulb eases Usuall y, stings and bites of pains, removes rash and blisters, poisonous animals were treated and promotes epithelization of the with external remedies: fresh skin when applied externally.38 juices, decoctions, and infusions Birch (Betula spp., Betulaceae). of different plants. In most cases, In the Caucasus and Central Asia, these plants had only analgesic birch baths of European white and anti-inflammarory effects, birch (B. pendula Roth.) are used but did not inactivate the poison for external ulcers and wounds.25 itself. An example is fresh juice of To prepare a bath, it is recom basil (Oimum basilicum L., Lami mended ro infuse a teaspoon of aceae), which is used roday in the budding leaves in 100 ml of Azerbaijani folk medicine against boiling water {Pers. comm. A. bee stings. However, some other Muradov, conversation, 1993 plants are known as antidotes. January in Baku, Azerbaijan). In Himalayan regions, a decoction of Scorpion stings the bark of Himalayan birch (B. Ajowan ( Trachyspermum ammi uti/is D. Don) is used ro wash {L.) Sprague ex Turrill, Apiaceae). wounds.39 Birch preparations were Ibn Sina recommended using a used successfully in the Central local bath of ajowan seeds against Clinic of the First Moscow scorpion srings. 11 Other medieval Central Asian bathhouse as illustrated in a Persian book University against erosion of the authors also confirm analgesic and miniature from the manuscript of Poems by the Uzbek skin and conditions when the antidotal properties of this bath poet Alishir Navoi (1 441- 1501). wound does not heal for a long 15. 17.34 time.40 According ro Azerbaijani folk medicine, decoctions of Calamus or sweerflag (Acorus calamus L., Acoraceae). ajowan seeds have antidotal and analgesic properties, when Mu'min wrote about the anti-inflammarory and healing applied externally. Taking a bath with this decoction causes properties of the juice and decoctions of sweerflag. 17 In the same effect {Pers. comm. B. Samadova, conversation, modern Russia, alcoholic infusions of the dried rhizome is 1988 June in Lachin, Azerbaijan). This plant does nor grow diluted with water (3: 1) and applied on festering wounds in Azerbaijan, bur is imported. and ulcers as a local bath.4 1 Soft Tissue Damage Rheumatic and neuralgic pain Traditional medicine often cures soft tissue injuries and For many centuries, medical baths were successfully used ailments with the help of local baths. Juices, infusions, and ro treat rheumatic and neuralgic pain. Many recipes of decoctions of aromatic plants are applied externally ro the these bath solutions are found in ancient Greek, Roman, wounded parts of the body. T his practice is still widespread Indian, and Arabic medical sources. In modern Azerbaijan, in the folk medicine of Caucasus. this practice is applied in the Naftalan health resort, where patients take baths with aromatic plants and unique heal Wounds, tumors and ulcers ing Naftalan mineral oil. Baths with mustard oil are Cinnamon {Cinnamomum verum J. Pres!, Lauraceae). extremely popular in the folk medicine of Caucasus. Khoyi in 1311 C.E. pointed out that cinnamon has anti- 46 I HerbaiGram 57 2003 www.herbalgram.org Radiculit is rosemary leaves, and the mixture infused for a half an hour. Mustard (Brassica nigra (L.) W.O.]. Koch. , B. juncea (L.) The infusion is then filtered and added to the warm water Czern., Sinapis alba L. syn. B. alba Raben h., Brassi caceae). in the bath. T he optimal durati on of the procedure is half The Tibbname recommends external application of an hour (Pers. comm. T. Aydinov, conve rsation, 1992 mustard water in the form of baths or December in Baku, Azerbaij an). compresses to relieve pains in radi culi Stewart recommends a rose mary ti s (inflammation of the root of a bath for tension and stiffness .42 This nerve) _22 In Azerbaij an, bathing in bath may have a pharmacological effect mustard water is prescribed for those since the hot in fusion of rosemary is who suffer from chronic radiculitis. It known as a toni c,-'8 and an anti-s pas is recommended to add I 0- 15 table modic, 43.44 and antiviral agent.' spoons of mustard powder to a pot Neurasthenia and tachycardia contai ning 2- 3 glasses (400-600 ml) of water. The powder should be vigor English lavender (Lavandula angus ously ground until the sharp smell of tifolia Mill., Lamiaceae). Ancient mustard becomes apparent. The Greek scholars such as Galen and powder is added and carefull y mixed to Dioscorides, as well as medieval phar a bath containing 20 buckets of water macists, report the strong calmative 111 (approximately 200-250 liters) . The properties of lavender. · 7 According to temperature of the water must be simi Azerbaij ani folk medicine, bathing in a lar to the temperature of the human lavender decocti on has anti-s pasmodic body. After bathing, it is advised to put and calmative effects and is used for on a bathrobe and take a nap (Pers. tachycardia (rapid heart beat) and comm. T. Aydinov, conversation, 1992 neurastheni a (Pers. comm. A. December in Baku, Azerbaijan). Muradov, conversa ti on, 1988 Decem Mustard oil s are contraindicated when Central Asian bathhouse. A 16th century ber in Baku, Azerbaij an). Persian book miniature. kid ney d isor d ers exist, and prolonged Stewart recommends lavender baths applications may res ult in skin and for tension and stiffness .42 T his bath nerve damageY contains lavender oil, which is applied for neuras thenia, 4 The analgesic properties of mustard baths are thought to migraine, and heart neurosis with tachycardia. ' Baths with depend on the sinigrin content and the volatile o il lavender may relax the patient since isolati on of a smooth contained in these plants. Externally, mustard is a local irri muscle relaxant principle identified as 7 -methoxycoumarin 36 tant applied against rheumatic pains, rubefacient, and vesi al so has bee n reported. T he bath may be taken before cant in ove r-the-counter drugs, such as Musterole®.5 sleeping because lavender oil is effecti ve fo r insomnia. 46,47 Sweet marjoram (Origanum majorana L. , Lamiaceae). Nervous and Cardiovascular Diseases Dioscorides and Ibn Sina considered this plant to be good Many aromatic herbs are used medicine against different nerv 11 17 to treat various nervous and ous diseases. · According to cardiovascular diseases. The Azerbaijani folk medicine, taking derived benefits are associated a bath with a marjoram decoction with the sedative effect of so me is hel pful against fl atulence and volatile oils contained in these nervousness, and causes a diureti c herbs. effect (Pers. comm. F. Safarov, conve rsatio n, 1993 August in Low blood pressure Shamakhi, Azerbaij an). T he heal Rosemary (Rosmarinus o./fici ing properties of marjoram baths nalis L. , Lamiaceae). In Azerbai may depend on the sedative prop jan, rosemary baths are recom erties of the vo lati le o il (0.7 to 3.5 mended to people with low percent) contained in this plant.4° blood press ure. Since medieval Lemon balm (Melissa ojfici times, it has been thought that nalis L. , Lamiaceae). T he Tibb this fragrant plant stimulates name recommended external and circul ation of the blood and is a internal applicati on of lemon good toni cY Four glasses of boil An Egyptia n tomb painting dating from 2nd millenium balm to rel ieve excessive nervous B.C.E. depicts the ea rl y practice of aroma therapy in ing water are added to a pot ness and irritability.22 According ancient Egy pt: a servant woman offering to the ruler two containing fi ve tablespoons of to Azerbaij ani folk medicine, ja rs with aromatic herba l ointments. A number of such bathing in a lemon balm decoc- ointments we re applied to the body after bathing. ======&======~ www.herbalgra m.org 2003 HerbaiG ram 57 I 47 tion is useful fo r heart disease, relieves tachycardia, elimi macology of these herbs and their constituents suggest nates pains in the heart, and lowers blood pressure. that these ancient and traditional folk ideas continue to be Further, lemon balm baths are applied for furunculosis. relevant. ---' The water in a bath must be warm, but not hot (Pers. comm. S. Valibeyov, conversation , 1987 April in Shusha, Farid U. Alakbarov, Ph. D., graduated .from the Biological Azerbaijan). Department ofthe Baku State University and holds degrees of Information about the healing properties of lemon balm Doctor of Philosophy and Doctor of Sciences. As the Head baths may be confirmed by data of Leclerc, who reports Scientific Officer at Baku's Institute ofManuscripts, his main that lemon balm has anti-arrhythmic activity and is fields ofresearch focus upon the history ofmedicine, and tradi successfull y used to treat different types of arrhythmia and tional and folk medicine and pharmacy. H e has authored 78 high blood pressure.3 8 scientific and educational articles. Conclusion References To study the ancient recipes of herbal decoctions used in 1. Franchi mont P, Juchmes 1, Lecomite J. Hydrotherapy: bathing during the Middle Ages and earlier, 18 medieval Mechanisms and indications. Pharmacal Ther 1983;20: 79- manuscripts in Arabic, Persian, Turkish, Greek, and Latin 93. 2. Lawless J. An Illustrated Encyclopedia of Essential Oils: The were investigated. T hese medieval sources contain informa Complete Guide to the Use of Oils in Aromatherapy and tion about more than 50 aromatic herbs that were used in Herbalism. Boston: Element Books; 1995. the preparation of medicinal baths. Some of these plams 3. Young DG. An Introduction to Young Living Essential Oils. are listed and discussed above. 6th ed [pamphlet]. Payson (UT): Young Living Essential As a result, a number of forgotten m edieval recipes have Oils; 1999. been revealed and deciphered. It has been established that 4. Petkov V, editor. Modern Phytotherapy (in Russian) . Sofia, aromatic baths were used to treat reproductive, urinary and Bulgaria: Medicine and Physical Training Press; 1988. intestinal disorders, skin diseases and all ergies, stings of 5. Tyler VE, Brady LR, Robbers JE. Pharmacognosy. 9th ed. Philadelphia: Lea & Febiger; 1988. poisonous animals, damage of soft tissues, rheumatic and 6. Alakbarov FU. Medicinal plants used in medieval Azerbaijan neuralgic pains, nervous and cardiovascular diseases, and phytotherapy.} HerbaL Pharmacother 200 I; I (3):35-49. more. Some modern scientific literature on arom atic plants 7. Maniche L. Sacred Luxuries: Fragrance, Aromatherapy, and has been analyzed as well. Comparative a nalysis of Cosmetics in Ancient Egypt. Ithaca (NY): Cornell University medieval and modern sources shows that recent investiga Press; 1999. tions support the possible medicinal effect of som e ancient 8. Salmela OW. The Sauna. Minnetonka (MN): Otsa Press; recipes. Sometimes the healing effects of herbal baths may 1995. be associated with known medicinal properties of the 9. Dymock W Pharmacographia Indica. London, Bombay, Calcutta: 1893. Reprinred by Hamdard, The Journal of the constituents of aromatic herbs. In stitute of Health and Tibbi (Medical) Research, Pakistan, Medical manuscripts of the ancients contain d escrip 1972. tions and recipes of many herbal baths. Some of them also 10. Hutchens AR. Indian Herbology ofNorth America. Boston & are used by modern folk medicine in different countries of London: Shambala Press; 1991. the world. Modern research on the chemistry and phar- 11. Ibn Sina A. Kanun ji at-Tibb (Canon of Medicine) (in Arabic). 2nd vol. Manuscript from the collection of the Institute of Manuscripts in Baku; copied in 1143. 12. Ziyari KI. Gabusname (in Azerbaijani) . Translated from Persian by R. Sultanov. Baku: Azerbaijan State Publishing House; 1989. 13. Ibn Sina A. Kanun ji at- Tibb (Canon ofMedicine) (i n Russ ian). 3rd vol. Translated from Arabic by Bulgakov PG, Salye MA. Tashkent, Uzbekistan: FAN Press; 1980. 14. Ibn Sina A. Kanun ji at- Tibb (Canon ofMedicine) (in Russ ian). 1st vol. Translated from Arabic by Salye MA, Karimov UI, Rasulev A. Tashkent, Uzbekistan: FAN Press; 1981. 15. lravani HSG. Fava'id al-Hikmat (Benefits of Wisdom) (in Persian). Manuscript from the collection of the Institute of Manuscripts in Baku. Code B 39/ 19955; copied in 1834. 16. Alakbarov FU. Ancient prescriptions for health: the Aptek Museum and Bathhouse. Azerbaijan International 2000;8(2):20-2. 17. Mu'min MM. Tuhfot al-Muininin (Gift ofTrue Believers) (in Persian) . Manuscript from the collection of the Institute of Manuscripts in Baku Code C-364/ 18446; Copied in 17 13. Naftalan health resort in Azerbaijan where patients with arthriti s, skin diseases 18. Mansur IM. Kifoyayi-Mansuri (Sufficient from Mansur) (in and other conditions are treated with the help of aromatic bath and the Nafta Persian) . Manuscript from the collection of the Institute of lan oil, a rare type of healing oil found only in Azerbaijan. The photo was taken in 1958. Photo courtesy of Azerbaijan State Archive. ~~~~~~~~~=&======~ 48 I HerbalGram 57 2003 www.herbalgram.org Manuscripts in Baku Code C-817 /9770; copied in 1653. 34. Ansari AH. lkhtiyrzrat-i-Bad'i (Book of Bad'z) (in Persian). 19. Baum SJ. Nutrients for a healthy heart. Altern Med Manuscript from the collection of the Institute of Manu 1999;30:66-72. scripts in Baku, Azerbaijan. Code D - 61 1136; copied in 20. Kidd R. Herbal help for ear infections. Herbs for Health 1818. 2000;5(2):64-7. 35. Jayaweera DMA. Medicinal Plants (Indigenous and Exotic) 21. Goryachev MI. Volatile Oils in Flora of USSR (in Russian). Used in CeyLon . Parr 3. Colombo: A Publication of National Alma-Ata: Publishing House of the Kazakhstan Academy of Science Council of Sri Lanka; 1981. Sciences; 1952. 22. Anonymous. Tibbname (Book of Medicine) (in medieval Azeri). Manuscript from the co ll ection of the Institute of Manuscripts in Baku; copied in 17 12. 23. Khoyi Yl. Jam aL-Baghdadi (Baghdad's CoLLection) (in Arabic). Manuscript from the co ll ection of the Institute of Manuscripts in Baku; copied in 1519. 24. Maragayi A. Mualijati-Munfarida (Exceptional Treatment) (in Persian). Manuscript from the collection of the Insti tute of Manuscripts in Baku. Code B 2490/4115; copied in 1797. 25. Damirov LA , Prilipko LI , Shukurov DZ, Kerimov YB. MedicinaL Plants ofAzerbaijan (in Russian) . 3rd ed. Baku, Azerbaijan: Maaraif; 1988. 26. Khalmarov HH, Kharlamov lA, Mavlankulova ZI. Medic inaL Plants of Central Asia (in Russian) . Tashkent, Uzbek istan: Ibn Sina Press; 1998. 27. Grosourdy R. EL Medico Botanico CrioLLo. La Habana, C uba: lmprenta La Cubana; 1964. 28. Martinez MJ, Betancourt J, Alonso-Gonzales N, Jauregui Roman baths. Illustration from The Book of Perfumes by Eugene Rim mel, 1865. A. Screening of some Cuban medicinal plants for antimi crobial activity. J EthnopharmacoL 1996;52: 171-4. 36. Said HM, ediror. Hamdard Pharmacopoeia ofEastern Medi 29. Kaul VR. Indian} PharmacaL 1977;38(1):21 -2. cine. Karachi, Pakistan: Times Press; 1970. 30. Lambrev Z, Yankov N, Ajarova Y, Bichvarova M. Nauchni 37. Anonymous. Chjud-Shi (Monument of the Medieval Tibetan trudove VSI "Kolarov." (in Bulgarian). 1960; 8:3 11 -3 17 Culture) (in Russian). Translated from Tibetan by Dashiyev 31. Gardner JA. The art of Artemisias. The Herb Companion D.B. ovosibirsk: Nauka; 1989. 2000; 12(4):28-33. 38. Leclerc H. Precis de phytotherapie. 5th ed. Paris: Masson & 32. Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall Cie; 1976. T, Riggins CW, Rister RS, edirors. Klein S, Rister RS, trans- 39. Jayaweera DMA. Medicinal Plants (Indigenous And Exotic) larors. The CompLete German Commission E Monographs & Used in Ceylon. Parr I. Colombo: A Publication of the Therapeutic Guide to Herbal Medicines. Austin (TX): Ameri National Science Council of Sri Lanka; 198 1. can Botanical Council; Bosron (MA) : Integrative Medicine 40. Lovkova MY, Rabinovich AM, Ponomareva SM, Buzuk Communication; 1998. G , Sokolova SM. Why Do Herbs Cure? (in Russian). 33. Ritch-Krc EM, Turner NJ, Towers GHN. Carrier herbal Moscow: auka; 1989. medicine: an evaluation of the antimicrobial and anticancer 41. Gammerman AF, Kadayev, GN, Shupinskaya, MD, activity in some frequendy used remedies. J Ethnopharmacol Yatsenko-Khmelevski, AA. MedicinaL PLants (in Russian) . 1996;52: 151-6 2nd ed. Moscow: Visshaya Shkola Press; 1976. 42. Stewart S. Easy aromatherapy for midlife. Herbs for Health 2000;5(2):42-5. 43. Chen QH, Shi HoC. Effects of rosemary extract and major constituents on lipid oxidation and soybean lipoxygenase activity. jAm Oil Chemist's Society 1992; 69:999-1002. 44. Hoppe HA. Drogenkunde. Berlin & New York: Walter de Gruvrer Press; 1977. 45. Perrot E, Paris R. Les PLantes Medicates. Paris: Presse Univer sitaites de France; 1974. 46. Hardy M. Sweet scented dreams: vaporized lavender oil as a nocturnal sedative for elderly patients with sleeping difficul ties. lnt J Aromatherrzpy 1991 ;3(2): 12-3. 47. Minton M. Combine herbs & massage for better health: relieve pain, stiffness, arthritis, and more. Herbs for Health 2000;5(2):58-62. Turkish ba ths. Il lustration from The Book of Perfumes by Eugene Rim mel, 1865. www.herbalgram .org 2003 HerbaiGram 57 I 49 Lavender. Photo Aromatherapy by Jane Buckle, Ph.D., R.N. SO I HerbaiGram 57 2003 www.herbalgram.org Aromatic plants were used in ea nderthal rimes 1 and have Method of use played a part in healing throughout history. Most cultures have Aro matherapy may produce both psychological and physiologi included aromatic plants in their use of herbal medicine, as shown cal effects. The psychological effects of aroma ca n be rapid, and by references from ancient C hinese, Indian, Tibetan, Australian may be relaxing or stimulating, depending on the previous ex peri and ew Zealand, North Ameri can, South American, Egyptian, ences of the individual as well as the chemistry of the essential oils Roman, and Middle Eastern sources. Traditionally, aromati c used. Essential oil s may also be appli ed topica ll y to the ski n and essences were inhaled , used topically, or ingested. Both volatile and may eli cit a rapid phys iological affect (i.e., cooling o r warming). nonvolatile plants were used in herbal medicine, and aromatherapy While so me aromatherapisrs do not consider topi cal or ingested did not become separated from herbal ism until quite recently. The essential oi ls as part of aromarh erapy, others contend that the topi word "aromarherapy" did not become popular until after World cal, ingested, and inhaled uses of essential o il s are aromatherapy. War II. Gattefosse's book on aromatherapy was published in 1937 . Much depends on the background, perception, and training of the That same yea r, Hunt published Fragrant and Radiant Healing person conducting the aromatherapy, and what that person is Symphony in England, in which he used the word "aroma-therapy" trying to achieve. when discussing the uses of plant scents. Both authors had previ The co nfusion around what is, and what is nor, aromatherapy ously published works in which they used the healing power of may have occurred with the renaissance of aromarherapy in France plant essential oils. Gattefosse, a French chemist, had used these and its ex port to England in the 1950s. French physicians used o il s since 1897. topical applications, ingestion, and inhalation, the method chosen The break of arom arherapy from herbal medicine may have according to irs clinical appropriateness (e .g., inhalation for respi coincided with the advent of the pharmaceutical age when herbal ratory tract infections, or for psychological effect; ingesti on for 2 medicine almost became extinct. This paper ex plores the different intestin al complai nts; topical application fo r burns, skin , and ways aromatherapy is perceived by different factions and artempts muscular problems). T hese methods are clearl y outlined in to answer the question, "Does aromatherapy belong in herbal Aromatherapie (The Practice of Aromatherapy), a book first medicine?" published in 1964 by Vainer,- a French physician who used topi cal, oral, and inhaled applica tions of essential oils with his patients. Aromatherapy Vainer documented the use of essential oi ls for wound healing and The definition accepted in most aromatherapy schools is, infection control. H e wrote, "Essence of rhyme [Thymus vulgaris "Aromatherapy is the therapeutic use of essential oil s. ".l Essential L., Lamiaceae] destroyed rhe anthrax and bacillus and was a o il s are defined as volatile parts of aromatic pl ants extracted by stronger antiseptic than phenol." Vainer used essenrial o il s in steam distillation or ex pression. infected wounds, therefore his methodologies would not be Although one of the lesser-known complementary therapies in accepted as aro matherapy by those who dispute that aromarherapy the United States, aromatherapy has been accepted as part of nurs is inhalatio n only. ing care in rhe U nited Kingdom. British nurses are insured by the Belaiche, another French physician, used all three methods of Royal Coll ege of Nurses to use essential oils (both topically and applyi ng essenrial oils with his parienrs and documenred them in inhaled) for improved patient care, provided their hospital his three-volume work on clinical practice, Traite de Phytotherapie approves and without a doctor's specific instructions. Further, et d'Aromatherapie, published in 1979.H so me hospitals also allow non-nursing perso nnel to use esse ntial Garrefosse (often refe rred to as the grandfat her of aromarherapy) o il s. Aromatherapy is also used by nurses in Australia, New used rhe word aromatherapy and also used topical, ingested, and Zealand, Canada, Germany, and Switzerland," and is becoming inhaled essential oils. He wrote, "Knowledge of how smell s are popul ar in the United States. More than 30 states allow the use of absorbed and incorporated is important because, to be effective, some complementary therapies (including aromatherapy) as a part rhey must penetrate the skin. We know that rhe ski n is more of holi stic nursing care. porous to gases rhan to liquids and solids. Gases and thus aro mas, Some essential oils were listed for oral use by the Ameri can whether highly pervasive or nor, incorporated in glycerides, read Medical Association in Useful D rugs, published in 1930.' Although ily penetrate the skin where rhe blood ca n transport rhem. "'J Price and Price suggest that aromarherapy first made its appearance Despite Garrefosse's assertion rhat essential oi ls are absorbed not in the United States in rhe 1980s/' aromarherapy massage oil s were just into the skin , but through the skin into the blood stream, this produced and sold nationwide from 1967 and early aromatherapy remains a contentious iss ue among aromarherapisrs. Gattefosse's courses were established during the mid- 1970s. However, since the Aromatherapie: Les H uiles Essentielles Hormones Vr!gitales, ori ginally 1980s, the popularity of aromatherapy as a complementary ther published in 1937, was translated into Engl ish by Louise Davies apy has escalated. Aromatherapy products have become big busi and edited by Robert Tisserand. Tisserand is well known for his ness, as a trip to natural foods and herb products stores will pioneering work in aromatherapy and for co-authori ng an excel confirm. lent book on essential o il safety. 10 The perfume and the food and drink industries funded much of the research into natural essential oils. Essential o il s were originall y Absorption of essential oil components used in the perfumery before they were deemed roo expensive and through the skin replaced with synthetic aromatic compounds. Essential oils were Jager et aJl 1 showed that linalyl acetate and linalol, two compo also used to add taste and smell to consumables until they, roo, nents in essential oil of English lavender (Lavandula angustifolia were replaced with synthetic compounds. The vas t array of low Mill., Lamiaceae), were absorbed from a 2 percent dilution of cost aromatherapy products on the market usually contains in ex Engli sh lavender in peanut oi l through the abdomin al skin of pensive syntheti c fragrances, as a glance at the label will ve ri fy. lr human subjects "within minutes" and detected in the blood must be emphasized that most aromatherapists contend that plas ma (ca. 10 ng/ ml). The maximum level was attained at 20 synthetic aromatic compounds are not part of aromatherapy, and minutes; even at 90 minutes, the two components could still be such compounds have been linked to the growing emergence of detected. fragrance sensitivity. www.h erbalgram.org 2003 HerbaiGram 57 I 51 Fuchs et al 12 demonstrated that (R)-(-)- carvone easily pene also viewed essential oils as drugs that should not be administered trated the skin of human subjects, producing a plasma concenrra orally without a prescription. As a result, oral appli cations were not tion of 24-32 ng/ml after almost 30 minutes. Covering the skin inrroduced into England with the topical and inhaled methods produced a signifi cantly higher effect. Twenty-five percenr (R)-(-) used at this time. Since then, aromatherapy has become synony carvone in peanut oil was used. (R) carvone is an isomeric ketone mous with massage (i.e., topical appli cations) and this association found in caraway (Carum carvi L. , Apiaceae). (L) carvone is found continues today in the United Kingdom. The concentration of in spearmint (Mentha spicata L., Lamiaceae). esse ntial oils used by nurses in massage is also quite low - typi Wyers and Brodbeckll demonstrated that l ,8 cineole was cally 1-3 percent solutions of essential oils in cold-pressed ca rri er absorbed through the skin into the muscles. They found that when oi l. Only during the last five years, si nce 1998, has oral use of an applicator was used the absorption rate increased 320 percent. esse nrial oils (so metimes ca ll ed aromatology, a term used with In an email in June 2002, Buchbauer, who led much of the different connotations, depending on who is using it) arrived in ex perimental work on topical absorption at the Institute of Phar England. The Royal College of Nursing insurance policy, which maceutica l Chemistry, University of Vienna in Austria from the insures nurses, does not cover oral use. In France some physicians use essential oils orally. Aromatherapy massage is not carried out by French nurses. However, because of its name, many people cominue ro think that aromatherapy is only about smelling something. That is incor rect. The usual definition is, "Aromatherapy is the use of essential o il s for therapeutic purposes." 11 No methods are suggested. But, clearly, only essential oils are used. If this definition were accepted, this would exclude synthetics and solvent-extracted absolutes that are obtained by petrochemical ex traction. Expressed oils are the only exception that appea rs to be accepted by the aromatherapy world. Expressed oils are only obtain ed from the peel of citrus fruit (e.g., lime [Citrus x aurantifolia (Christm.) Swingle, Rutaceae], lemon [C. x limon (L.) Osbeck] and grapefruit [C. x paradisi Macfad.]. Most aromatherapists do not think that carbon dioxide ex tracted oils are essenrial o il s, as they have not been obtained by distillation. The argument against anything other than distillation appears to rest on method (heat) and potential impurities from petrochemical solvents. However, a ca rbon dioxide-extract would contain no impurities, although the chemistry would be different. Choosing a method The method of administering an essential oil in a clinical setting will depend on the symptom being treated. A bruise needs a topi cal compress, not an inhalation. Because essential oi ls are extremely volatile, however, some part of the essential oil will be inhaled and have a psychological effect. When pleasant, relaxing smell s and gentle touch are used in tandem, the effect can be deeply relaxing. Both smell and touch are two powerful non-verbal methods of communication that cross all language barriers. 16 Of the three methods of appli cation (oral, topical, inhaled), inhalation has the most rapid effect. Chemical components within the essential oil bind to receptors in the olfactory bulb and have an almost instant effect on the hypothalamus and amygdala, which are located in the limbic part of the brain, where memory and smell are sa id to resideY Mills writes that the lipophyllic compo nents in essential oils actually penetrate the blood-brain barrier. 1H In animal experiments, Buchbauer1'J showed that inhaled essenrial oil compounds could pass the blood-brain barrier and be detected in brain tissues (especially the cortex) of mice who inhaled single vo latile fragrance compounds for 20 minutes. 1980s, is very clear, "It is now common knowledge that fragrance Jager et a/.2° reported an increase in the cerebral blood flow in compounds are absorbed through the skin into the blood stream." the cortex of human subjects after inhalation of I ,8-cineole from Maury, an Austrian nurse who worked as a medical assistanr to an unspecified source. Similar studies by Nasel et a/.2 1 found the a surgeon in Alsace, France, prior to World War II, was instru increase not only in normal healthy subjects, but also with a menral in transporting aromatherapy to the United Kingdom in woman with anosmia (the inabi li ty to smell). the 1960s. 14 Maury researched how essential oils affect the skin in While tincmres are a common way of using herbs, essential oi ls such conditions as psoriasis. She stated that she introduced her are rarely administered orally by aromatherapists. This could be ideas to the beauty industry in England (rather than nursing) as because most aromatherapy training suggests the oral method is she thought that beauticians would be more interes ted in topi ca l fraught with danger. However, many essential oils may be admin appli cations of essential oils. She and her student, Daniele Ryman, istered orally with safety. 52 I HerbaiGram 57 2003 www.herbalgram.org Most aromarherapisrs will offer a choice of essential oils ro their Antimicrobial effects of parienrs. Most smell likes and dislikes ca n be linked ro lea rned essential oils memory and a negative connotatio n could compromise rhe Possibly because aromarher proposed psychological effecr. This is parricularly obvious in a apy is perceived ro be useful aromatherapy: mulri-cultural society where rhe ubiquitous lave nder may nor be as mainly for stress, rhe anrimi What is it? appea ling ro someone ro whom iris unfami li a r. If a perso n who is crobial properties of essenrial bein g treated for depression dislikes basil (Ocimum basilicum L. , oils have nor been acknowledged. Many essential oils have anri Lamiaceae), oil of bergamot (Citrus bergamia Risso & Poir. , bacrerial,l' anrifungal,·16 and anriviral properties ,~' Some in vitro Ruraceae), lavender, or patchouli (Pogostemon cablin (Blanco) studies have indicated rhar essential o il s are effective agai nst such Benrh. syn. P. patchoufy Peller., Lamiaceae) could be offered with bacteri a as merhicillin-resisranr Staphylococcus aureus (M RSA),.'H equal chances of success. Because essemial o il s are highly concen res istant Shigella,.'') and resisran r Escherichia coli bacteria. 40 rrared, only 1- 5 drops of essemial o il s rend robe used ar one rime Most studies of essential oil s are in vitro, bur these are gradually whether diluted in carrier o il , or inhaled direct from a corron wool being repeated in human studies. West Indian lemongrass was or floating on rhe rop of hor water. found ro be as effective (in a 2.5 percent cream) as four other The importance of smell commercial creams against ringworm and clinical isolates of four dermarophyres in vitro.41 Each of rhe commercial creams had T he sense of smell is importanr ro human beings throughout clorrimazole, isoconazole nitrate, keoconazole, benzoic acid, and 22 rheir lives. Babies use it ro idemify their morhers, and depression salicylic acid as rheir main active ingredients. of elderl y persons in residemial facilities may be reduced by the smell of flowers. 21 The seem of eucalyptus (Eucalyptus globulus Labill., Myrraceae) can increase crearivity, 24 cirrus, (Citrus spp., Ruraceae) may enhance immune funcrion, 25 lavender and clove (Syzygium aromaticum (L.) Merr. & L.M. Perry, Myrtaceae) can improve cognitive processing,26 and rose (Rosa spp., Rosaceae) and bergamot orange (Citrus bergamia Risso & Poir. , Ruraceae) can be relax ing. r Unfortunately, rhe so urce species is nor always specified in rhe published literature. Some esse ntial o ils have been found ro have analgesic effects when inhaled, taken orally, or appli ed ropicall y. Topically applied essemial oils of lavender, Roman chamom il e (Chamaemelum nobile (L.) All., Asreraceae), neroli (Citrus aurantium L., Ruraceae), mandarin (Citrus reticulata Blanco, Ru raceae), sandalwood (Santalum album L. Sanralaceae) , palmarosa (Cymbopogon martinii (Roxb.) j.F. Warson, Poaceae), and geranium (Pelargonium spp. , Geraniaceae) were found ro enhance pain relief in children wirh Lavender (Lovondulo spp.) is a sou rce for essential oils used in aromatherapy to human immunodeficiency virus (HIV). 2HTop icall y appli ed laven relieve pain and depression, and improve cognitive processing. der was also found ro be effective in reducing perceptions of pain 2 in critical care serr in gs. ~ Sherry er al42 reported on a chronic case of MRSA osteomyel itis. West Indian lemongrass (Cymbopogon citratus (DC. ex Nees) A 49-year-old man had sustained an open fracture ro his left tibia. Stapf, Poaceae) was shown ro have ropical analgesic effects and He underwenr debridement and insertion of an inrramedull ary 10 appeared ro increase rhe effects of morphine.· The componenr in nail. Eighteen months later rhe wound still had nor healed and, West Indian lemongrass rhar produces rhe analgesic effect is des pite continuous antibiotic therapy, he had chronic MRSA 11 myrcene, a monorerpene. Topically applied Roman chamomile osteomyelitis. Amputation was being considered. In December reduced rhe perception of pain by parienrs with cancer in a 2000, via a 3 em percutaneous incision, rhe lower tibia was washed randomized study by 5 1 parienrs. One of rhe parienrs in rhe study our with 4,000 mls of saline, then packed wirh calcium sulfate said, "I know most definitely rhar ir [aromarherapy] has helped me pell ets impregnated wirh essential oils of West Indian lemongrass 12 in my quest for pain relief. "· In each of rhese studies, diluted eucalyptus, rea rree (Melaleuca altemifolia (Maiden & Berche) essential o il s were appli ed ro pi call y in a massage so iris difficult ro Cheel, Myrtaceae), clove, and rhyme in an ethanol base. One ml extrapolate what analgesic effects are attributable solely ro rhe of rhe essential oil mixture was administrated daily via a carherer. essenrial o il s. The dilution and ratio of rhe essential oils was nor given . Three However, in a si ngle case-study, inhaled damask rose essential oil months later, rhe wound had healed and rhe culture was clear. An (Rosa damascena Mill., Rosaceae) was found ro be highly effective x-ray showed complete healing. The authors commem rhar essen in reducing rhe perception of chronic pain in a parienr wirh ri al oi ls have a strong antim icrobial action, are inexpensive and uncontrollable pain, despite parienr-conrrolled morphine analge simple ro use, and can be used ropically. sia.ll Cerrainly ir is rhe experi ence of rhe author and many of her Anderson and Fennessy" ·' reviewed rhe literature on topically students rhar essenrial oils can affect relaxation, and rhar in itself appli ed essential oil of rea tree and concluded rhar there was can alter rhe perception of chronic pain, maki ng so mething rhar compelling evidence of rhe effectiveness of essential oil of rea tree was unbearable, bearable. Candace Walsh, R.N., wrote, "I have against MRSA. Caelli er al 44 rook rh e leap from in vitro to humans come ro understand rhar essential oi ls and rouch can be a power and applied rea tree ro human subject in a randomized, controlled ful parr of any health package. T hey add an elemenr of comforr pilot srudy (n = 30) using a 4 percent nasal ointment and a 5 and relief rhar promotes well being o n rhe menral and emotional percenr body wash. The rea tree mixrure was more effective rh an 4 levels and can help ro reli eve pain."l rh e control (3 percent mupirocin nasal oinrmenr and triclosan www.herbalgram.org 2003 HerbaiGram 57 I 53 listed such as orange peel (Citrus sinenszs (L. ) O sbeck, Rutaceae) and ginger root (Zingiber officinale Roscoe, Zingiberaceae) contain essential oils. Of the 200 hundred or so esse ntial oil s in common use, eight essential oils are specifi cally named by the C ommission E list of approved herbs (see Table I ). Therefore, to some ex tent, aromatherapy is recognized, even approved, by the Commiss io n E. Essential oils listed by the Commission E Interes tingly, the Commission E monograph for lavender includes lave nder essential oil for internal use and as a bath additive. Some of the ei ght Commiss ion E monographs listed in Table 1 specify the amount of essential oil present in rhe dried herb, ranging between 0.05 and 15 percent. The whole herb contains chemicals such as bitters, saponins, tannins, and alkaloids. T hese will not be present in the essential oil when it has been distilled from rhe plant. C ertain pl ants are safe to use in herbal medi Massage oils that include diluted essential oils for aromatherapy have been sold in the United States, cine, bur are not safe to use as essential oils. T his and has been an accepted nursing practice in the United Kingdom since the 1960s. is because when rh e whole herb is used, the essen ri al oil co mponent is very small , but the ac ti ve body wash). All pati ents maintained IV antibiotic cover. This is of ingredienrs within rh e concenrrared essential oil become too particul ar interes t to those in rh e fi eld of infection control, where powerful. T his is the case with arnica (Arnica montana L. , or A. pathogenic orga nisms are becoming res istanr r~ .a nnbtoncs. Vainer chamissonis Less. ss p. fo!iosa (Nun.) Maguiere, Asteraceae) . found many essenrial o il s also had gentle ann-mflammatory and However rh e C ommissi on E monograph can be confusing because analgesic properties, were good antimicrobi als, and were useful 111 it li sts "arnica oil." This is not an essential oil but an ex tract of 1 other chronic diseases such as arthritis and bronchitis/ part herb to 5 parts fi xed oil. Arnica essential oil is contraindicated Further in vitro studies indica te that essential oils like rosemary in aromatherapy and described as "highl y toxic." 51 (Rosmarinus officina/is L. , Lamiaceae) are effective against oppor T he hear and stea m used to produce essential oil of chamomile tunisti c in fec ti ons such as Cryptococcus neoformans.45 Sandalwood (Matricaria recutita L., As reraceae) release a chemical call ed essenri al o il was shown to have anti viral acti vity against herpes chamazulene, which renders the essential oil a bright blue. T he simplex 1 and 2 in vitro. The essential o il appeared to interfere herbal ex tract is not blue. T his chamazulene (a sesquite rpene) gives with rh e virus's ability to replicate.46 the essential oil irs class ic anti-inflammatory properties. In fac t, its The role of aromatherapy in herbal medicine anti-inflammatory properties are thought to be comparable to hydrocortisone. 52 A li ving aromatic plant contains ve ry small amounts of essential Roman chamomile (Chamaemelum nobile (L.) All., Asreraceae) oil. When rhe essential oil is extracted, that extract can be up to is as important in aromarherapy as rhe chamomile also commonly 100 rimes more potent than the plant irself. 47 Some herbalists, called German chamomile (M atricaria recutia L. , Asreraceae) . such as Zyelsrra, believe the use of essential oils on their own (i .e., Whereas German chamomile essential oil is bright blue in color, not as parr of the whole herb) is sufficiently different for Roman chamomile is colorl ess to very pale blue as rh e chamazu aromarh erapy to stand outside co nvenri onal herbal medicine rr.ain lene conrenr in Roman chamomile is minimal. However, Roman ing. D uring a July 1997 meeting between rh e author, rhe C hatr of chamomile fl owers grown in England have rh e brightes t of pale Botani ca l Medicin e ar Bastyr Uni ve rsity, Lisa Meserole, N .D., and blue. Roman chamomile may al so be used as an ami-inflamma Zyelsrra ar the Coll ege of Phyrorh erapy in H ales ham, Suffolk, tory, bur is used more oft en in aromatherapy as an antispas modic England, Zyelsrra was very emphati c about this. C learly, the Mass and sedati ve. achuse ttS Srare Board of Nursing considers aromarherapy d1fferent from herbal medi cine as it accepts aroma therapy as part of holisti c Some contraindications to clinical use nursing, bur not herbal medicine. "H Ar rh e 1994 National Insti If essenrial oils are being used for a clinical condition, it makes tutes of Health conference, "Botanicals: A Rol e in U.S. H ealth good se nse that the perso n using the oils is trained ~o . use them care," the panel of ex pert herbali sts needed seve ral minutes ro clinica ll y. Even if essential o il s are not being used clm1call y, tt IS answer rhis ques tion fro m the fl oor, "Is aromarh erapy part of bes t ro understand how ro use them safely because they are so herbal medicine? " The answer was a ve ry hes itant, "Yes. " concentrated. Essential oils such as cinnamon (Cinnamomum Plants in common verum ]. Pres!, Lauraceae), whi ch contain a large amounr of phenols, can have a burning effect when applied undiluted ro the Looking at both the Complete German Commission E M ono skin .47 Some topically applied essential oils may affect rop1 cally graphs49 and Potter's Cyclopaedia of Botanical D rugs, 50 it becomes applied conventional medicines. Almirall et al 53 found that 1,8 obvious rh ar aroma therapy and herbal med1 c111e are closely related. cineole, d-limonene and pinene, from unspecified sources, perme "Essential" or "vola ril e" oil is mentioned 100 rimes in the index of ated rhe skin and affected topical application of conventional the Commiss ion E monographs, probably because many herbs drugs such as haloperidol and chlorpromazine. Whereas cineole 54 I HerbaiGram 57 2003 www.herbalgram.org and d-limonene enhanced the rransdermal permeability of crossover in term s of plants haloperidol, d-limo nene reduced the transdermal permeabiliry of shared o r methods used , ir chlorpromazine. Jori et al. 54 studied rhe effects of several essential makes sense that aro marh er o il components o n the m etabolism o f drugs in rats. T he compo apy sho uld have a separate aromatherapy: nents, which were delivered by aerosol or subcutaneously, were training fro m herbal m edi What is it? eucalyptol ( I ,8 cineole) from an unspecified source, guaiacol fro m cme. an unspecified source, menthol from an unspecified source, and Furthermore, if essen ri al pine needle oil, which also contained alpha-pinene, phell andrene, oils are to be used clinically, rhe author recommends rhar any train dipentene, sylvesrrene, and bornyl acetate. Of rhese, rhe m osr ing be clinicall y based. M ost, tho ugh nor all, aro marherapy courses impo rtant effect was from eucalyptol, which was shown to increase focus o n pleasure rather than cl inical o utcomes . Essential oils are, the acri viry of the microsom al enzym ati c reactio n and alter the in the main , pl easant to use, bur because they are so m uch more metabolism of drugs . The disappearance rate of amphetamine and concentrated than herbs, sm all am ounrs may have excell ent thera pentobarbital was increased from brain and plas ma, bur eucalyptol peutic effects. Synthetic aro mas will nor p roduce the same thera had no influence on phenylbutazone. peutic effects as essential o ils and could be harmful, as these compounds have been linked to an increase in sensiriviry, as thma, Summary and all ergies. -" C onfusion remains as to what aro marherapy really is. It is j ane Buckle, Ph. D., R.N., is Executive Director ofR .j. Buckle Asso perceived to be separate from herbal medicine, although clearl y ir ciates, a consultancy in clinical aroma therapy founded in 1995. Dr. is deri ved from herbal medicine. Buckle advises boards ofnursing and medical establishments on safety, The effects of essential o ils could be attibured to placebo ethics, and research, and has pioneered the clinical use ofessential oils res ponse, the effect o f to uch and smell on the parasympathetic in healthcare (particularly nursing). Widely published, her second nervous system , the learned memo ry of aroma and related psycho clinical book, C linical Aro marherapy: Essential O ils in Practice, is logical effects, the pharmacokineri c enhancement of orthodox due in March 2003 . She has created and instructed academic courses drugs by essential oils, or to pharmaco logicall y active ingredients and is Adjunct Faculty at four leading universities. Her certification within essential o il s. course, Aromatherapy for Health Professionals, is endorsed by the T hese effects can occur however the essential o ils are applied , American Holistic Nurses Association, is used by Planetree Hospital whether topicall y in a bath, massage or compress, inhaled , or Group, and has been taught in 25 states. Her shorter home-study ingested . The vast majoriry of essential oils used in aromarherapy course has been positively critiqued by Andrew Wei!, M.D. For more rend to come from plants that are nor used in herbal medicine. information, please visit 56 I HerbaiGram 57 2003 www.herbalgram.org International Trade Centre Market News Service North America The most important medicinal plants launches Reports on Worldwide Herb Markets cultivated in North America for domestic by Mark Blumenthal use in dietary supplement products (US) and/or natural health products (Canada) as well as for export include aloe, American he International Trade Centre (lTC) In addition to the quarterly Medici nal ginseng root, cayenne fruit, Echinacea T Marker News Service (M NS) now Pl ants and Extracts report, lTC M S also purpurea flowering tops, Echinacea produces quarterly reports on Medicinal Issues reports on: purpurea root, evening primrose, feverfew Plants and Extracts. ITC is the Geneva • Fresh Tropical and Off-Season fruit leaf, flax seed, garlic bulb, hop strobile, and based technical cooperation agency of the and vegetables (85 tropical and off peppermint leaf. The most important wild United Nations Conference on Trade and season products in 12 European collected medicinal plants in North Amer Development (U CTAD ) and the World markers and five Middle Eastern ica include black cohosh rhizome, cascara Trade Organization (WTO) for opera markets, weekly); sagrada bark, Echinacea angustifolia root, Echinacea pal/ida root, goldenseal root, tional, enterprise-oriented aspecrs of trade • Fresh C ut Flowers (65 varieties in four passionflower herb, slippery elm bark, and development. Asian markets, 94 va ri eties in 12 Euro saw palmetto fruit. [Editor's note: Recent The repo rt covers marker conditions, pean markers, 26 varieties in six North taxonomic studies have provided genetic regulatory news, and conservation issues in American markers, each weekly) ; and phytochemical evidence to support the North America, Western Europe, Eastern • Tropical and Ornamental Young Plants 1955 conclusion of the botanist of the Europe, Japan, C hina, and India. The (5 varieties in five Eu ropean markets, famous American botanist, Arthur Conquist secnon for each geographical regio n every t\vo weeks); (7919-1992), that Echinacea angustifolia includes market trends and statistics on • Bulk-Packed Fruit Juices (I I products DC. should be renamed as E. pallida (Nutt.) specific raw botanicals and extracts, a brief in the European and U.S. market, Nutt. var. angustifolia (DC.) Cronq.] profile on a key herb in that region that every t\VO months) ; The supply for most North American botanical raw materials has been steadily incl udes trade specifications commo nly • Spices, Spice Seeds and H erbs (30 tightening up. Presently, both the wild used in that region, plus other related data, products in Asia, Europe, the M iddle crafted and cultivated supply chains have including trade fairs , conferences, and East and the United Stares, weekly); some common and different issues affect symposia. Ri ce (more than I 5 different varieties ing them. The supply of wildcrafted medic T his report also includes a profile on rhe and grades in worl d markers fro m inal botanicals is increasingly impacted by United Plant Savers (UpS), an Ameri can South East Asian, American and Euro a number of factors including loss of habi organization that identifies at-risk medici pean o rigins, every three weeks), and tat from development, logging operations, nal plants in rhe U nited Stares. Each edition • Pharmaceutical Starring Materials/ conversion of prairie to pasture, [collection highlights news in the field of medicinal Essential Drugs (more than 300 of rhe constraints imposed by environmental plant conservation worldwide, prepared by most used substances in the produc and] government agencies concerned TRAFFIC International, the worldwide tion of essential drugs [generics] in with threatened or endangered species, collection by the ornamental plant trade, fl ora and fauna monitoring organization. major m arkers, monthly). and to a lesser extent from the medicinal T he Report also includes a special profile MNS seeks to improve its service and plant wildcrafters themselves. Many expe on American G inseng Root (Panax quinque expand its information net\Vork and marker rienced wildcrafters have given up the filius L., Araliacea), a profil e on the regula coverage. Companies and o rgan izations trade in recent seasons due to some or all tory process and situation in Canada, and a willing to join its Information Providers' of the aforementioned obstacles to trade. regional focus on the market conditions in net\Vork may contacr 58 I HerbaiGram 57 2003 www.herbalgram.org stating that they have sold off the last of recall). In the meantime, in the US, many 2002pres/20020614.html>. their inventories and may remain out of botanical raw material suppliers have Quality Standards: Official monographs stock until the fall of 2002. Some plantings discontinued carrying ephedra due to providing quality standards and tests for have been lost to Dutch elm disease, which significant increases in product-liability Cascara sagrada and Elm bark are published is causing some growers to reconsider insurance expenses. In some cases six-fold in the U.S. Pharmacopeia (USP 25th revision whether they'll replant this crop in the increases have been reported while some 2002). Official standards for Garlic, Ginger, future. Elm USP is used as an OTC demulcent insurance carriers have threatened to Peppermint, and Saw palmetto are active ingredient in sore throat remedies discontinue coverage altogether unless the published in the U.S. National Formulary (lozenges, syrups and teas). suppliers discontinue stocking ephedra. (USNF 20th edition 2002). Standards for Many companies have announced that they American Ginseng root are published in the New Record Low Demand for US may decide to remove ephedra from their Pharmacopoeia of the People's Republic of Cultivated Hops products because insurance coveragl'! has China (PPRC English Edition 2000). Stan As of March 1, 2002, the sold ahead posi become prohibitively expensive. Another dards for Black Cohosh can be found in the tion for the US hop industry set a new record complication is that China is requiring US American Herbal Pharmacopoeia (AHP low with only 66.57 percent of the total importers of ephedra to obtain so-called 2002) and for Wild Cherry bark in the British projected yield contracted. Consequently, Letters of No Objection (LONO) from the Herbal Pharmacopoeia (BHP 1996). acreage reduction efforts are underway Drug Enforcement Agency (DEA) before PRODUCT SPECIFICATIONS (Saw palmetto which are expected to significantly lower Chinese exporters can release shipments. fruit soft extract) 2002 production compared to 2001 . A target Meanwhile, on Friday, 14 June 2002, the [Editor's note: This section includes nomencla reduction of 6,500 acres represents about U.S. Department of Health and Human ture, physical and chemical parameters {includ 4,535,970 kg of hops that would not be Services (HHS) announced "new efforts to ing solvent information. pesticide residue limits produced this year. In 2001, 30,314,841 kg expand scientific research on the safety of etc.), microbiological data, storage conditions were harvested. While most hops are culti ephedrine alkaloids," and referred to its {including packaging and shelf life), and thera vated for breweries, a small amount is sold recent funding of the Rand Corporation "to peutic and regulatory information.] into the medicinal plant trade for use in conduct a comprehensive review of the MEETINGS AND TRADE SHOWS sedative products. existing science on ephedrine alkaloids, [Editor's note: The report includes a list of particularly those in dietary supplements." upcoming conferences, symposia, and related First Quarter US Imports and This action is viewed as being supportive of events of interest to the medical plant commu Exports of Herbal Teas long-standing American Herbal Products nity.] _A Association (AHPA) policies for the market In the first quarter of 2002, the US ing of ephedra products but the announce This report was published with permission imported 360,257 kg of herbal teas repre ment was disappointing to foes of the of the Market News Service of the Interna senting a Customs Value of US $2,216,000. dietary supplement industry who have been tional Trade Centre UNITAD/WTO. For further The main herbal tea exporting countries, in lobbying for the removal of ephedra from information, please contact order of predominance, were Canada, China, the market. The HHS Press Release can www.herbal gra m.org 2003 HerbaiGram 57 I 59 International Symposium Explores Chemistry and Pharmacology of Plants Used in Traditional African Medicine by Andrew Marston , Ph.D. he Afri can nation of Mali was rhe venue for a sy mposium O rh er themes included a review of plants as a source of new Torga nized by the Working G ro up on Pl ant C hemistry of the d rugs, together with an outline of methods for rh eir biological and Internatio nal O rganiza tio n fo r C hemi cal Sciences in D evelopment chemi cal sc reening by Prof. H ostettmann, and insights inro hi gh (lOC O). T hi s confe rence, held March 6- 8, 2002, in Bamako, thro ughput screening from the indus trial side by Bruno David , Mali , bro ught together scientists from African countries (princi Ph . D ., of Gro upe Pi erre Fa bre, in Ra mon ville, Fra nce. Rero Brun, pall y Wes t Africa) and orher counrries inreres red in rhe inves tiga Ph .D ., of rh e Swiss Tropicallnsrirure, Basel , Switze rl and, descri bed ti on of Afri can u adirional medicine. T he inrention was ro provide rh e evaluati on of African medicinal plants for their acti vities against an insight into rhe current stare and future trends of the subject. Trypanosoma, Leishmania, and malari a paras ites. Finall y, Beri r G roup C hairman Kurr Hosrettmann, Ph.D., of the Unive rsity of Smes tad Paulse n, Ph.D., from rhe School of Pharmacy, Uni ve rsiry Lausanne, Switze rl and, and the local orga nize r, Orissa Diall o, of O slo , Norway, described the rrearmenr of wounds in Mali an Ph.D ., of rh e D epartmenr of Traditional Medi cine (DMT), lnsri traditio nal medicine, wirh emphas is o n the polysaccharide rur Nati onal de Recherche en Sanre Publique (I N RSP), in Bamako, consriwents of rhe plants in vo lved. assembled a vari ed program of pl enary lectures, short lecwres, and T he plenary lectures were accom pa nied by two poster sessions posters. T he offi cial opening ceremony incl uded speeches of and a se ri es of 17 short lectures from representatives of rhe fo ll ow welcome from rhe Malian Ministers of Health and Educa ti on and ing countries: Mali , Ethiopia, G uinea, Ivo ry Coast, Morocco, Togo, from Boubacar C isse, Ph.D ., rhe Rector of rhe Uni ve rsiry of Democratic Republic of Congo, Senegal, Burkina Faso, Italy, Bamako. Jea n-Marie Lehn, Ph. D ., co-winner of rhe 1987 Nobel Sweden, and Switze rl and. Prize in C hemistry, pres ident of rh e lOCO, and professor ar rhe T he meeting was was attended by 120 parti cipants, of whom Louis Pas teur Unive rsiry, Srrasbo urg, France, made inrroducro ry approximately 50 were from Mali. Despite rh e difficult conditions remarks. in many African counrries, ir was rewarding ro see rhe quali ty of The scienrific conrriburio ns of the meeting covered recent research in many universiti es and institutions. Nor o nl y are in ves ti adva nces in research on medi cin al plants fro m east, west, and ga ti ons underway into rhe compositio n and acrivi ry of planrs used central Afri ca. Of rhe 10 plenary lecturers, six were from Afri ca and in Afri ca n traditional medi cine, bur improvemenrs and large-scale four from Europe: applicati ons of rhe preparati ons are being repon ed. • T he first plenary lecture was give n by Jacob 0 . Midiwo, T he symposium was preceded by a two-day workshop wirh two Ph.D ., of rhe C hemistry Departmenr of rhe Univers ity of rh emes: 1) the quali ry control of raw plant materi al and phyrophar Nairobi, Kenya, who gave a review of phytochemical studies maceuri cals, and 2) rhe formulati on of improved traditional medi on Kenyan medicinal plants. T hese species have furnished a cines. This was organi zed jointly by rhe Deparrment ofTrad irional wide range of natural products wirh anri feedanr, antimicrobial, Medicine, lnstirur National de Recherche en Sante Publique in insecti cidal and nematocidal acriviries. Bamako and the lnsrirure of Pharmacognosy and Phyrochemisrry • T he lecture by Or. Diall o similarl y provided information abo ut of rhe Universiry of Lausa nne, Switze rl and. Some 20 parricipanrs rhe chemical constitution of M ali an medi cinal plants. from differenr African counrries received training in vario us as pects • Pierre G ui ssou, Ph.D ., of rhe lnsri rur de Recherche en Sciences of rhe preparati on and analys is of pl ant drugs . de Ia Sante, D epartement de Medecin e er Pharmacopee Tradi T he lOC O was created in 198 1 by a group of scientists from 15 ti onnell es in Ouagadougou, Burkin a Faso, spoke abo ut rhe countries our of a concern abo ut rhe barriers thar hinder the introducti on of validated planr-based preparations for use in research efforts of chemists in developing countries. T he Working rhe country of Burkina Faso. These preparations are all based G roup on Pl anr C hemistry of rh e lOC O , chaired by Prof. upon traditional remedies for such ailments as paras iti c H osrerrmann, links scienrists in developing countries wirh diseases and inflammatory conditions. researchers in industrial counmes in coll aborati ve research on • Messanvi G beassor, Ph.D ., of rh e Centre de Recherche er de topi cs of mutual interes t. Formati on sur les P!antes Medicin ales, Uni ve rsity of Lome, in T he first symposium o rganized by rhe Working Group on Lome, Togo, also presented rhe stare of research inro improved Pl ant C hemistry rook place in Vi croria Fall s, Z imbabwe, in phyromedi cines in his country, wirh a case study of rh e insec 1996. Since then, further symposia have been convened in ticid al applications of neem (Azadirachta indica A. Juss., Meli Panama C iry, Panama, a nd Bangkok, T hail and. T he next m eet aceae) . ing is scheduled to rake pl ace in C uba in November 2003. T he A similar theme was rreared by Emmanuel Bassene, Ph.D ., of Wo rking G ro up o n Pl a nt C hemistry websi te IS the Laboraroire de Pharmacognosie er Boranique of C heikh 60 I HerbaiGram 57 2003 www. herbalgram.org ungle Medicine, by Constance Grauds, better than Wade Davis' One River or F. herbal formulary with a slightly different JR.Ph. 2001,206 pp., sofrcover. ISBN 1- Bruce Lamb's Wizard ofthe Upper Amazon. slant than usuall y found in Traditional 928595-08-1. $ 14.95. ABC Catalog # Connie also has an indelible sense of C hinese Medicine (TCM ). Now, at the top 851 4. humor which she magica ll y weaves through along with these has to be Jake Fratkin's A hero and a the book. It adds a li ght touch to an other latest edition of Chinese Herbal Patent heroine, a shaman wise provoca tive subject (healing the sick!). Medicines. apprenticin g a Connie leads you into the deep forest as if C hinese patent medicines are ready- made shamana, pl ants that you were her guardian angel sitting upon preparations used by Traditi onal C hinese speak, medicin es her right shoulder with a good view of the herbali sts and freely access ible to the general from the rainforest, journey. Step by step, mile by mile, always public. There are literall y thousands of dreams rhar come returning to her beloved rainforest. C hinese patent medicines, most of which true. All this and For the layperson who has only watched are produced under exemplary Good more is packed into television documentaries about indigenous Manufacturing Practice (GMP) standards 206 pages of a new healers who concoct medicines from jungle regulated with stringent requirements as to healing and adven plants, Connie has an exciting tale to rell. their quality and safety by government ture book called To the everyday pharmacist or healthcare agencies not diss imilar to the U.S. Food and j ungle Medicine. Connie Grauds is a phar professional who can remotely relate to the Drug Administration. macist from California who was a partici exc itement of discovering the rudimentary The classical sources for many of the pant on the first "Pharmacy from the Rain beginnings of their own profession in rhe parent formulas demonstrate that most of forest" ex pedition to rhe Peruvia n Amazon world's greatest pharmacy (the rainforest), these products have a history of clinical effi with the American Botanical Council and Connie evokes the certai nty that it can cacy extending well over 2,000 years. Each Internatio nal Ex peditions in 1994. This happen to anyone who works on fulfilling herb is li sted by C hinese pinyin , pharma book is an autobiographical account of her their dreams. ceutical name, botanical name, common evolution from dise nchanted retail pharma T he "s hamana" experience that Connie name, and by the va rious traditional thera cist to modern-day shamana. Ir is quire a attains at the end of her narrative is a deeply peutic categori es such as AA (ronify qi) , AB metamorphosis. perso nal achievement, a higher calling rhar (ron ify blood), J (s top bleeding). This Although jungle Medicine is a personal most people could not eve n fathom. How a important class ifi cation is readily available voyage of discovery, it is also a high-s pirited jungle-taught shamana functions in the on the back cover of the book. adventure told from the heart, rhe mind, modern-day San Francisco Bay area is prob T he products are cl ass ified according to and the intell ect with conviction and fa sci ably nor as important to understand as her their traditional and modern pathological nation. She reA ects upon her earl y yea rs as reason for doing it. Overall, jungle Medicine use with commentary and differentiation of an HMO pharmacist, getting burnt-out, is a great weekend read . ..- each, so rhar if one wants to find a product developing ca ncer, going through a divorce, - Daniel T. Wagner, Pharm.D., R.Ph ., MBA for the common cold , Au or nasal disorders , and seemingly at rhe end of her sa ni ty. Nutri-Farmacy 82 products are li sted under eight subcate Along comes Don Antonio, a Yagua Wildwood, Pennsylvania gories. The second section includes infec shaman, who becomes her spiritual teacher tions, fevers and internal heat, which refer in the fores t, as well as in her dreams. hinese Herbal Patent Medicines: The to vi ral and bacterial infections with 84 What is very pleasing about rhe book is CClinical Desk Reference, by Jake Paul products described in seven categories of Connie's elega nt style of writing. Reading Frarki n OMD, LAc. Shya Publications: inAuenza, so re throat, genito-urinary infec through jungle Medicine, one would assume Boulder, Colorado, 62 I HerbaiG ra m 57 2003 www.herbalgram .org C and the ways that many natural Phys icians who anempt to use this book nurse in rhe world of herbs while reaching compo unds alter their activity. T his well to generate rational CAM therapeutics for how to integrate borh traditional and wrirten chapter explains clearly rhe complex their cancer parienrs will be frustrated. The biomedical knowledge inro rh e nursing generic and cell signaling pathways rhar book is nor organi zed by cancer type, so rhe paradigm. Reading abour rh e hi story of make a cancer cell different from a healthy clinician will need to use the index to find herbs in rhe nursing profess ion will be of ce ll including p53, Jos, myc, jun, ras, Bcl-2, relevant information scartered througho ut special inreres r to nurses. The vira li sr view epi ge netic gene instabili ty, redox modula rhe book. While ir would be useful if the po int and extensive herbal practices of tion, protein tyrosine kinase and protein book was in a format to design potentially Florence Nightingale may come as a pleas kinase C, and topoisomerase. T he chapter effecti ve, low toxicity protocols for patients an t surprise to nurses and herbali sts alike. on rh e interaction of natural compounds with breast, colon, lung, prostate, and ovar O ne chapter is devoted to rhe preparation wirh radiation and chemotherapy is ve ry ian ca ncer, as well as rh e leukemias and of bas ic herbal applications: reas, foods, useful. Mr. Boik has responsibly and lymphomas, more eas il y, rhe current ve rsion ex ternal preparations, and environmemal respectfully ci red credi rs for dara and already pushes rh e envelope of whar can be rherapies. T he C D-ROM features 17 vi deos figures, and rh e references are thorough. recommended ar rhi s rime from such an rh ar demonstrate their preparation and This wi ll (or should) be a core texr in oncol immature resea rch base. application for parienr use; reason eno ugh ogy medical programs ar leading edge John Boik's purpose is to offer a rational to consider buying rh e C D-ROM. unJ ve rsJnes. approach ro experimental cancer therapeu T he next rwo-rhirds of rhe book, more Boik's method was to search MEDLI E tics and rhis book should inspire a whole rhan 600 pages, is devoted to derai led up to rhe year 2000. Already rhe book is our program of research. I hope rh e arional profiles of 58 plams commonly used for of dare. The mosr recent papers cired were Insrirures of Hea lrh and major univers ity hea ling. The aurhor groups these plam done in 1999 [rhe author updates rhe cancer cenrers are paying arremion to the profi les into healrh patterns along rh e lines research online ar www. herbalgram .org 2003 Herba!Gram 57 I 63 ket contrain dicati on statemenrs cl inically still needs to defin e how herb ca re will be occasion ro appreciate rhis resource during useless. Further, there is also no discuss ion integrated into nursing practi ce. C urrently, my recent trips to the John C hris topher of the key safety considerations for lactation many stare regul atory boards are offi cially School in Utah , where I sometimes reach, as needed to ass ist interpretati on of such state "s tudying" rhe iss ue (i.e., nor raking action). do my good fri ends Steven Foster and Chris ments to mothers. In all fa irness to the T his inacti on has potential for both good Hobbs, rhe authors of rhis guide who are author, these deficiencies are the norm for and bad. Taking note of rhe historica ll y train ed borani srs and herbali sts with more profess ional herbal li terature to dare. Some independent nature of herbal care by than 60 years of combined ex peri ence. of rhe lactatio n-related info rmati on is nurses, the author warns against nursing Treating close to 500 species, and wirh hidden in other profil e sections; hav ing ir all regulations rhar would limit nursin g prac some 530 photographs rhar illustrate rhe in one place would have been preferabl e, ti ce to rhar covered by a phys ician's order. pl ants, their fl owers, leaves and fruit, the es pecially when using rhe CD-RO M . She ri ghtly perceives that such regulations book is a real treasure and a great buy, T he pediatric in fo rmation section is mos t would res ult in overkill , similar to regul a almost a steal, for the price. There are more welcome, as rhere is a great need for rhe ti ons rhar would make all herbal medicin es than 300 species in rh e Western guide nor pediatric nu rse to be herbally competent to prescription drugs. covered in rh e Eastern guide, A Field Guide counsel parents. T his book will be a grea t T he las t secti on features a summary of to Medicinal Plants and Herbs: Of Eastern help, as many (most) herbals for healthca re effective ways ro communicate with and Cen tral North America , which was profess ionals do nor even mention pediatric patients about herbs, providing guidelines authored by Foster and myself. This latest use of herbs, let alone show a willingness to on how, when, and ro whom to refer book is hisroricall y accurate, based largely discuss specifics of use (the "j ust say no pati ents; required reading fo r all nurses. based on erhnoboranical and scientific liter strategy) . T he herb profiles also consider References are li sted by chapter in rh e back ature. Orga nized by flower color for fast caunons, nursing evidence (hi storic and of the book. T he C D-ROM provides rapid identification, rhe guide al so includes an potential uses, integrati ve in sights), thera alphabetical referral ro each herb profile; index to medi cal topics to quickly locate peutic appli cati ons (types of preparations, one can find the herb using rh e numerous information on specific ailments. Symbols dose ranges), potential nursin g applications, common names provided or the botanical next ro the plant descriptions provide quick and pati ent interaction. name- your choice. visual warnings for poisonous and allergenic The informati on for patienrs section has O ve rall , this book and the accompanying pl ants. permiss ion from the author for copying and C D-ROM will greatl y ass ist nurses . Even The descriptions al so include botanical may be pri nted from rhe CD-ROM for use for rhe nurse who cannor ye r imagine using descriptions, ethnobotanical and cross as a handout. N urruring the nurse-plant herbs with pati ents, rhe book is an excellent cultural usage information, and distribu relati onship secti on has wonderfull y counseling resource. Both rhe book and rh e tional and habitat com men rary. The creati ve activities inspired by the autho r's C D -ROM would be excell ent rools for publishers claim this guide offers the bes t own relati onship with each plant. teaching. T here is enough information here and most comprehensive information avail T he fi nal chapters of rhe book discuss ro get a nurse starred on becoming herball y abl e in the world about rhe safe currently further learning opportuni ties, resea rch, ed ucated , while suggesting rhar there is popular and traditional uses of medicin al and the law. The discuss ion on rhe law will , plenty more to learn . An inspiring book ar pl ants of western North Ameri ca. The I am sure, be read ca refull y by all practi a ba rgain price. -"' authors have done well in selecting the tioners, as rhis is one hor topic. Even - Sheila Humphrey, BSc, RN more important uses ; however, a pocket mentioning possibl e herbal therapi es ro International Board Certified Lactation Consultant fi eld guide should nor be ex pected ro pati ents has brought phys ician accusations Marine on St. Croix, Minnesota include every hint of folk acti vity and indi of the nurse being a "kook" or of givin g cati ons for every herb, as we compilers medical advice. Many nurses have heard of Field Guide to Western Medicinal come ro learn roo soon. such incidents, o r endured them. W hile this APlants and Herbs, by Steven Foster What's new? I have a unique way to check secti on is a little shorr on providing rhe and C hristopher Hobbs. T he Peterson Field new books as rh ey cross my des k: What did specifi cs fo r bringing herbs in to Western G uide Seri es, sponsored by rh e National rhe authors carch that I missed during the hospital practi ce (e.g., how to deal with W ildlife Federation and preparati on of my own herbal desk refer infection control concerns), ir is a great PETERSON PIEI...OGUIDES " rhe Roger Tory Peterson ence? Let's rake a look at chi cory, which discuss io n of current legal and ethical chal lnsri ru re. H ough ron weighs heavil y on my mind this week. I lenges and oppo rtunities. Mo re success Mifflin Co., Bosron found a pure white- flowered specimen, srori es would have been encouraging read and New York. 2002. somewhat large r than rhe average blue ing (there are never enough of these!). 442 pp., 530+ colo r fl owered va ri ety in my abandoned pasture. I N urs ing regul ati ons pertinent to herb photographs. ISBN 0- have ir staked out, to see if irs seeds come care va ry by country and in the United 395-83807 -X hard true. I'll transplant it to my fl oral clock, Stares by stare. It is heartening to read that cove r $30.00, ISB N 0- digging those massive inuliniferous roots the Canadi an Nursing Associatio n consid 395-83806- 1 vinyl with care. This beautiful plant, one of the ers rhe use of complementary therapies such bound $22.00 all eged bitter herbs of rhe Bible, is a fairly as herbs, as fa lling wi thi n rhe scope of nurs Two of the greatest good clock fl ower, opening around 7 a. m., ing practi ce if such practice rakes pl ace herbal wri ters (a nd lecturers and biblio closing around I I or 12, depending on within rhe nursing process, wirh evidence of philic scholars) in rhe U nited Stares have humidity, ere. You can tell when your bus is the nursing process being used. C lea rl y, rhe fin all y done ir: rh e Peterson Field Guide to running late by rh e percentage of chicory profession of nursing in the United Stares Western Medicinal Plants and Herbs. l had fl owers that have already opened. It is said 64 I HerbaiGram 57 2003 www.herbalgram.org to be the best source of inulin, a major scientists are reluctant to se nd artemisinin to mosquitos. I disagree. History indicates prebiotic, and is the namesake of chicoric or arresunate to Africa, where malari a kills that the leaves were burned as a fum igant acid (also known as cichoric acid), which "1-2 million people each year, mos rl y chil insecticide to kill mosquitoes in ancient had its hour in the sun when it was toured dren." (Chap. 13) C hina. In 340 C.E., rh e renowned Daoisr, as a new approach to anri-AlDS activity. One reason not to se nd artemisinin to Ge Hong, recommended that to reduce In my comparison, I find 10 activities Africa appears in C hapter 15, "Since fevers one should soak a handful of qing hao and one indication for chicory in this guide artemisinin and irs derivatives are among in approximately 1 liter of water, strai n, and that are new additions to my research. Our the most effective antimalarials known and drink. T he classic C hinese herbal text, Ben authors did find room for the interes ting res istance to them has not ye t been Cao Gang Mu, states that malaria with chills quip about a relatively well -known use: observed outside models, use in each coun- and feve r could be treated with qing hao. "Roasted chicory root is commonly added try must be regu- Occasionally one finds contradictions in to coffee substitutes because of irs rich, ARTEMISIA Jared. " the book. " ... To dare there have been no slighrly bitter flavor; also used to flavor I attribute rhis published reports of clinical trials in which French roast coffee." It has been my experi rei ucrance to the A. annua herb has been used alone for the ence that several inulin-rich roots of the selfish fear of res ist- treatment of malari a." " ... A crude erhano aster family, Asreraceae, have folklorically ance, a consequence li c ex tract of A. annua was formulated with been scorched as coffee substitutes (e.g., of monochemical oil in a soft ge l capsul e and administered to chicory, dahlia, dandelion). approaches. Will mice and tried clinicall y in man." "The soft We can't expect a great pocket sized field whole sweet worm- gel capsul e was administered to I 03 guide like this to go into the derails of wood with patients with malaria (P Jalciparum or P prebiorics and anti-integrase compounds in cinchona bark vivax) and compared with the tablet formu the Biblical chicory. To keep ir concise, rhe (Cinchona spp. , lati o n whi ch was given to 4 1 malaria authors must select the most pertinent and Rubiaceae) and/or barberry (Berberis patients." "Both formulations were effective terse entries of interes t to field botanists and vulgaris L. , Berberidaceae) and/or epazote in reducing fever and clearing paras ites at herbalists. They have done well. (Chenopodium ambrosioides L. , C henopodi doses equivalent to 73 .6 g raw herb (fo r the What a great book, if the price is $22.00 aceae) prevent or treat malaria without lead capsul e), and 80.8 g (for the tablet) given and there are 600 species hinted at and 600 ing to resistance? The answer can only be over three days but recrudescent [recur photos, that's less than 4 cents per photo found through clinical trials. Such trials will ranee] rates were high with both dosage graph, with all that concise information for nor happen in the United Stares, I predict, forms although they were reduced by free. What a bargain. And what a nice gift for monetary reasons. It's hard to patent and increasing the duration of treatment. " " ... for your herbally inclined Western friends. control a whole herb, and harder to make Crude extracts alone may not give an But much of the information is also perti money therefrom. Afri ca , if I were yo u, I'd acceptable cure rare." nent back East roo. Get both for your trav start my own clinical trials. T his book added many quantitative data elling herbalists. --" More than half the pages on this mono and new entries to my phytochemical data -James A. Duke, Ph.D. graph on Artemisia, a ge nus of some 400 base at the U.S. Department of Agriculture, Botanist species, are dedicated to the one major anti alm ost doubling the number of quantified Fulton, Maryland malari al species, A. annua, which is also chemical entries. I'll se nd an e-copy of the commonly called sweet Annie and qing hao updated A. annua phytochemical li sting to rtemisia, edited by C.W. Wright. in C hinese, and irs deri vati ves. Single chap those readers who request it (e mail A Taylor & Francis. New York, NY. ters are devoted to A. absinthium, A. 66 I Herba!Gram 57 2003 www.herbalgram.org new patterns of behavior can develop and him rhan anyone else. His untimely passing snake's cantankerous mood. Once on a trip rake hold." gives us pause ro reflect on this unusual and wirh him to Guatemala, he hit a pothole A recent show at rhe U. S. Botanic remarkable man. which res ulted in nor one, bur rwo flar rires. Garden in Washington, D.C. fearured Dr. Marlin died ar home, without warning, No problem, he said . He flagged down a Wu's large works rhar he called "Gateways November 28, 2002. Marlin was 64 years passing truck. I was a bir intimidated by the to rhe Soul." His aim was to show rhar art old. H e was born in D ayton, Ohio on Janu yo ung men wirh automatic weapons slung may be used as a device to help alter rhe ary 18, 1938, and was raised in a religiously over rheir shoulders. Marlin didn't miss a normal sensory processes and connect with conse rvative German community. Marlin beat. H e enroll ed them into helping us. rhe deeper side of ex istence. His paintings always had a love for rhe land. His career Arone rime or another, Marlin had been came as visions wirh certain meanings, bur involved rh e pursuit of unusual agri cultural just about everywhere in rhe world, and had rhey are experi enced uniquely by each crops. The world was his garden. done jusr about everything he wanted to do. person. like prayer, meditation, nature, and T hose of us in rhe herb trade knew Although an expert in field production of even flowers, rhey capture rhe attention and Marlin as the Pres ident and CEO of Planta botanicals, Marlin was intensely curious reveal rhar which is usually unseen. They are tion Botanicals, located in Felda, Florida, about the world in whi ch he lived, and he portals to rhe sacred dimensions - rhe where he made his home wirh his wife and followed his multifaceted interests to their domain of rhe soul. When one gets in touch business colleague, Eva, since 197 1. Upon deepest potential. with rhis realm, powerful transformation meeting Marlin, some might have been lefr Marlin held a Masrer's degree in horticul and healing can take place. As a doctor, this with rhe impression that he was a simple ture from Purdue University. His early years was always his goal. As an arrisr, he helped farmer, easy to fool. But anyone who wirh his family were tough. Wirh five kids people create their own sacred connections. engaged in business dea lings with him, soon to feed, he even did a stint as a migrant fa rm His work was mosr recently on exhibit ar learn ed rhar behind his down-to-earth worker, piclcing fruit to pur bread on rhe the National Institute of H ealth, Gall ery I demeanor, was a savvy, creative, and deter table. Before children arrived, Marlin and Clinical Center, in Bethesda, Maryland. To mined entrepreneur whose will was to be Eva traversed the Amazon by canoe, coll ect view or purchase his art, please go to rhe reckoned with. There was nothing simple ing planr materi al for a pharmaceutical website: 68 I HerbaiGram 57 2003 www.herbalgram.org America. That journal honored him twice 1977 and together they built the business. spirits. There were rhe cayman, rhe boa, and with theme editions and the publisher, Else The shop still stands today, now one of the ar night the big cars hunting the little dee r. vier, sponsored a symposium at the Royal largest in Southern California, selling herbs, And the deer fl y even annoyed me there. At Botanic Gardens Kew to honor and thank teas, essential oils, ex tracts, hopes, and rhar special place, rhe screaming pija chants him for his years of service. dreams. loudly bur secretivel y, even when Antonio "Jeffrey Harborne was the most remark John had a gift for formulating. It was as and hi s ayahuasca smoke, and other forest able phytochemist I have ever known," if he had an inner vo ice pushing him toward spirits were nor there. recall s Tom Mabry, Ph.D ., Professor of new and uncharted territory. The ultimate "On rhis one rrip, Antonio had a bright Molecul ar Cell and D evelopmental Biology tinkerer, he'd work in the back of rhe shop. red base ball har rhar was solid with deer flies at the University ofTexas ar Austin. Mabry H e'd research, create, and then test. H e'd and swear bees. I pur a drop of John's new co-edited The F!avonoids (1975, C hapman improvise, refi ne, and perfect until he was repellent on the red hat. Moments later and Hall Ltd.) with H arborne. "His satisfied rhat his formula was just right. H e there was a red bull's-eye where John's common sense logic and insights as well as was rarely satisfied though, as he often revis formula had immediately repelled the crit his drive for excell ence always represented a ited formulas, altering and improving them. ters, more dramatically than rhe dreaded beacon for me. I will forever remember him All this was done as a personal goal or to synthetic DEET, forming a perfect red as my 'phytochemistry hero."' help others with their formulating. circle of repellency wirh just one tiny drop. H e is survived by his wife Jean, two sons, "You could count on John to come up "That night, Antonio dream ed of John's and seven grandchildren. --- with a new twist on an old formula, or to formula and confided to me rhe nexr morn -Karen Rob in introduce a new concept altogether," said ing, 'Your friend, Berry's husband [Berry [Sources: The University of Reading School of former herb and supplement manufacturer DuVall was along on this trip], has corrall ed Plant Sciences Herbarium News 70 I HerbaiGram 57 2003 www.herbalgram.org One problem I have with using this approach The one-in-eighr statistic refers ro li fet ime risk; dersrood, especiall y when not associated with excl usivel y, similar ro my concern with rhe I 0- women never, at any given point, have a one in explanations about li fetime risk. poinr sco ring system used by Fugh-Berman and eight chance of being diagnosed with breast Breast ca ncer is the leading cause of cance r Ernst* to assess interaction probability of ca nce r. Different sources quore different risks, death in women between the ages of 20-59. published case reports, is that the entire body of but I'll refer to Dr. Susan Love's Breast Book, 3rd Heart disease remains the lead in g cause of death ev id ence needs to be considered. Rarh er than ed. (Perse us Publishing, 2000). for women.' We do concur with Ms. Fi les that hav ing each study or case report stand o n irs At age 30, a woman has a I in 5,900 chance of educatin g consumers is often a tricky business own, there is a need ro assess whether other developing breast cancer in any given year. having to weigh the facts against running the ri sk research (additional studies, case reports, animal At age 35, it's I in 2,300 of scaring people into in action. and/or in vitro research) adds or detracts from At age 40, it's I in I ,200 - Cheryl Y. Kidd rhe likelihood rhar rhe At age 50, it's I in 590 Director of Education interacti on is for real. At age 60, ir's I in 420 Susan C. Komen Breast Cancer Foundation The ni ce parr about the At age 70, it's I in 330 Da ll.ns, Texas USP approach is that it At age 80, it's I in 290 I. Jemal A, er al. Cance r Statistics 2003. CA gives a standard for If yo u calculate our the number of women Cancer J Clin 2003 Jan-Feb;53( I): 18 . declaring clinical rele who eventually are diagnosed with breast cancer, vance (1 / ll). Everything the fi gure is anywhere berween I in 8 and I in N OT AS EASY AS IT LOOKS else is more or less rele- 10 over a span of 80 years, depending on whose jusr received my laresr Herba/Cram and va nt based o n the numbers yo u're using. For women berween 35 wanted you and your staff to know rhar rh e complete body of and 55, rhe numbers are quite different. The vast l issue looks great. The contributions of the Amer evidence and individual majority of women are diagnosed after age 50. ican Botanical Council to the understanding, ctrcumsrances. Breast cancer is significam cause of death for acceptance, and application of herbal products Ir has been imeresring getting a consensus of women between age 35 and 55, bur that's through rhe Herba!Cram and other activities opinions about published herb/drug in teractions because the mortality rare for that age group is continue to be truly exceptional. As an educator, from physicians in the associate fellowship of the low, nor because I in 8 are being diagnosed wirh researcher, and editor working with these plant Program in Integrative Medicine here ar rhe breast cancer. materials, I know that the planning, asse mbling, University of Arizona. They base their concerns Breast cancer is a terrible disease, seemingly and verifying of the articles and photographs large ly on the degree of outcome risk and use a moreso when it strikes yo unger women. And requires considerable rime and effort. sliding scale of evidence on this basis (s trong yo ur author is nor alone in quoting rhe I in 8 My issue of HerbalCram is used by undergrad evidence needed if little risk, little ev idence srari sric, which is frequently used ro emphas ize uate and graduate students as a reference source necessary if risk is great) with close moniroring how serious this disease is. Bur ir's misleading. on medicinal plams. In recom mending the for dosage or treatment adjustment. T his While ir is effective in motivating many women Herba/Cram, I am always glad ro know rhar rhe approach makes perfect se nse to me for doctors to ger mammograms, ir also creates a lot of fear, articles are science based and fully documented in practice. As for rh e self-prescribing general which in some cases actuall y prevents women with photographs, figures, and tables that help public (who rely on book or label recommenda from gettin g mammograms and can lead to the reader better appreciate the written material. tions, if anything), I believe recommending unnecessary anxiety (whi ch most people have Your Herbal Education Catalog is used by my greater caution is necessary. As yo u well know, plenty of to begin with). Let's be careful how we office to keep all of us aware of new books. one sign ificam adverse event can be used by the educate people - the ends don't always justify As a member of the Advisory Board , let me media to implicate as an inadvisable risk nor the means. emphasize rhar you are doing an excellent job only that herb, bur all herbs (and so metimes all I know for many people th is is splitting hairs, and rhar I am very pl eased to be associated with dietary supplements and alternative methods). and I pretty much take it with a grain of sa lt rhe HerbaLCram. My bes t personal wishes. I do nor like looking over my shoulder like a when I read or hear the I in 8 sraristic in popu paranoid suspect, but the breath on the back of lar media. It's easy to use, and effective. l gener - Lyle E. Craker, Ph. D. my neck has felt hot (a nd smelled bad) at rimes. all y expect more from HerbalCram, though. lr's Proftssor We'll have ro keep on working ro develop a a great source of information on an extremely University of Massachusetts, Amherst better understanding of relative risks and bene importam topic, and I'm glad yo u are covering fits, so that we ca n all make choices that are more important issues such as breast cancer. And Quilt safe and sound. for a Cure is a great article. lr's just that one lirtle - Francis Brinker, N.D. thing .... Lead !nstructor on Botanical Medicine for -Vicki Files HerbalGram welcomes letters to the the Associate Fellowship Healthy Steps Consulting editor as parr of the ongoing dialog Program in Integrative Medicine Rochester, New York that makes science so vibrant, and as University ofArizona, Tucson [Editor's note. We turned to the experts at the part of our efforts to learn as well as to Susan C. Komen Breast Cancer Foundation for a educate. Please submit your letters to 'see page 22 ofthis issue for a review ofthis arti response.] cle by Fugh-Berman and Ernst. - Editor Our usual so urces fo r the lifetime risk of devel Karen Robin, managing editor, via P RECISION IN STATISTICS opin g breast cancer are the National Cancer email [email protected]>, or am writing in response to the article Quilt for Institute SEER Program, or rhe American by postal service in care of the Ameri a Cure: Crafting Hope in HerbalCram 55. The Cancer Society. If a woman lives to age 80 and can Botanical Council, P.O. Box I above, she wi ll have a one in eight chance of author of the article, Mariann Garner-Wizard, 144345, Austin, TX 78714-4345, quo res rhe oft-repeated statistic of a o ne-in-eight developing breast cancer. The numbers quoted USA. Be sure to include your contact chance of developing breast cancer, whi ch while from Dr. Susan Love are very different from technically accurate is none-the-less mislead in g, either of these sources. information so we may confirm. and in the case of the age group she is referring Your readers may also want to refer to our The editors reserve the right to edit, website 72 I Herba!Gram 57 2003 www.herbalgram.org Cuba. Experience how acupuncture and other alter 75 1-7472 Email: In this departmenr of HerbalCram, we list resources such as publications, organizations, seminars, and networking for our readers. A listing in this section does not constitute any endorsement or approval by HerbalCram, ABC, or irs Advisory Board. XN International Congress of Dietetics provides resr, dosage, precaution, srorage, and the srrengrh make more informed healrhcare decisions and travel scholarships dietetics professionals from for each drug. For more information, contact: C hi provides in-depth information about effectiveness, developing nations who otherwise would be unable Z henguo. Fax: +86 755 26161829. E-mail: safety, interactions, pregnancy and breastfeeding ro attend the congress. Hosted by the America n If you haven't already bought your copies of these two outstanding reference books, take advantage of Low Prices on Both Commission E Publications The Complete German Commission E Monographs Therapeutic Guide to Herbal Medicines Mark Blumenthal, Senior Editor. Werner R. Busse, Alicia Goldberg, Joerg Gruenwald, Plus Shipping Tara Hall, Chance W. Riggins, RobertS. Rister, Associate Editors. Sigrid Klein, Ph.D., Item #CIS I Sen ior Translator; Robert S. Rister, Associate Translator. The original English translation by the American Botanical Council and the second ranked m edical book of 1998. Herbal Medicine Expanded Commission E Monographs by Mark Bl umenthal, Alicia Goldberg, and Josef Brinckman n Plus Shipping T his updated reference is based on the original, renowned Item #C181E Commission E translation by the American Botanical Council Credit card holders, order toll free 800/373-7105, fax 512/926-2345, or email: [email protected] 74 I Herba!Gram 57 2003 www.herbalgram .org Educating the public on the use of herbs and phytomedicinals Winter 2003 Herbal Education Catalog Featured Books WHO Monographs on Selected Medicinal Plants, Vol 2 By the World Health Organization. 2002. Provides a n additional collection of 30 monographs covering quality control and traditional a nd clinical uses of selected medicinal plants reviewed by 120 experts in more than 50 coun tries, as well as by experts through a network of relevant GOs. Also included are two cumulative indexes to both volumes. Softcover, 362 pp. Item #428A. Dang Gui Monograph From American Herbal Pharmacopoeia. 2003. Dang Gui Root The latest volume in the AHP monographs. ~ -(01 ;.. ) Dids ,_... """"'_\Jio. ... n'l'-.-•••· Includes a section on Traditional Chinese ...... __."' .. _ ..., , Medicine. Presents a comprehensive review __ of therapeutic uses, complete safety and toxi ~-- cology data, and critical information on side effects, drug interactions, contraindications, a ll aspects of quality control, historical use and more. Fully referenced and peer reviewed. Softcover, $ 19.95. #445. Special Offer -· Herba/Gram BackPacks Don't leave any gaps in your library. HerbaLGram back issues provide a comprehensive store of information on herbs, book reviews, research, and conference reports, legal and regulatory developments. BackPacks are a set of Herba!Grams from 1989, except the most current issue, and include a complete Cumulative Index. Order a complete set of BackPacks, Volume II, III and IV for $95 and you'll receive 2 slipcase at no extra charge to protect and tore tho e back i ue . That' a $19 value. To order, use the order form on the inside back cover or, for secure online ordering, please visit the Herbal Education Cata log section of our website: www.herbalgram.org ABC EXCLUSIVES Botanical Educating the public on the use of herbs and phytomedicinals Herb ucationCatalog Booklet Series he Herbal Education Catalog is back The eight-page booklets in thi s T by popular demand. You will note that series have reproductions of each plant a nd it is smaller and the number of items provide concise, authoritative, and accurate offered is fewer. This is, in part, a cost information on major medicinal plants. consideration. What we have listed here 301 Echinacea are newer items and the essentials - books 302 Siberian Ginseng and monographs that anyone interested in 303 Asian Gi nseng herbal medicine should have in their 304 Ginkgo 305 Milk Thistle library. We have more items on our Individua lly priced at 306 Peppermint website: sale books, closeout items, and 307 Chamomiles $100 special reports. Check them out at 308 American Gi nseng www.herbalgram.org or contact us for a 309 Goldenseal All l5. Item #300 list of what is available. 310 Feverfew $1250 3 11 Garli c Don't forget that if you are a member of 312 Valerian the American Botanical Council, you get a 313 St. John's Wort 314 Black Cohosh 5% discount on your purchases from our 315 Aloe catalog and website. For information on _...... membership, see page 2 of this issue of HerbaL Gram. Retail ers: Call us about placin g these booklets in y our store for y our customers' benefit. Complementary rack incl uded. Steven Foster Photography Medicinal Plants - Volume 1 CD-ROM This royalty-free CD ROM contains 102 photos of some of the most popular medicinal plants in use today. M edicinal Plants - Volume I is designed for both MacintoshTM a nd WindowsTM operating systems. The images a re high resolution: 8x 12 inches at 300 dpi (20.3x30. 5 em at 118 dpcm) and have excell ent highlight a nd shadow detail. Item #COOS ° For· products pmdu<.·cd in quantities ofless than 100.000 unit s. Alfalfa Calendula D andelion Goldenseal Milk Thistle Sarsaparilla Tomaro Aloe Cascara Sagrada Echinacea Goldenseal Root Mugworr Saw Palmetto Turmeri c American G inseng Castor Bean Elecampane Grape Vine Mullein Senna Valeri an Angelica Car's Claw Evening Primrose G reen Tea Niaouli oil Shepherd's Purse Weeping Willow Ashwaganda Catnip Fennel H awthorn Noni Shii take W ild Ya m Root Asian G inseng Cayenne Fenugreek H orse C hestnut Pale Purple Conefl ower Siberi an G inseng W itch H azel Astragalus C haparral Feverfew Kava kava Passionflower Sli ppery Elm Wormwood Bearberry C haste Tree Flaxseed Kudzu Pau D ' Arco Soybeans Wuweizi Bilberry C hickweed Fo-ri Lemon Balm Pennyroyal Squaw Vine Yarrow Black C ohosh C leavers Fringetree C hionan- Li cori ce Peppermint St. John's Wort Yellow Dock Black Elderberry Colt's Foot Flowers thus Lobelia Red C lover Stinging Nettle Yucca Borage Comfrey Garlic Maitake Reishi Sunflower Bugleweed C ranberry G in~e r Marshmallow Rosemary T huja Butterflyweed C ulver's Root G in go Mayapple Sage T hyme MONOGRAPHS ESCOP Chinese Herb Monographs ESCOP Monographs Chinese Drug Monographs and Analysis by H. Wagner, R. Bauer et a l. Monographs range from 8 to I 7 pp. and incl ude such Prepared by the European Scientific information as: pharmacopeias fo und in , publi cation first cited in, Cooperative on Phy totherapy oflicial drugs, substitute drugs, description of offi cial drugs, fa lsifi (ESCOP), a group of herbal experts catio n drugs, pretreatment of the raw d rug, medi cin al use, main "'"" fro m academia and industry in the constituents, pharmacology, toxicology, T LC fin gerprint analysis, MuMu'" U'IU E u ropean Unio n. These mo nogra phs evaluation, H PLC fingerpri nt analysis, and references. OrPt..v.ll},l· For a complete listing of monographed herbs and fascicule Herbe Houttuyniae Cordatae (Xuxingcao) Houttuy nia #0424G divisions, visit o u r website: for all 6 fascicules Itern #42 1 Herba Asari (Xixin) Asarum #0424 H www.herbalgram.o rg/mono graphs.h tm l $225 Radix Angel icae Pu benscenti s (Duhuo) Angeli ca #0424J Rhi zoma Atractylodes Macrocephalae (Baizh u) Atractalodes #0242K WHO Monographs on Selected Medicinal Rhi zoma Belamcandae Sin ensis (Shegan) Belamcanda #0424 L Plants, Vol. 1 Herba Lycopi Lucidi (Zelan) Lycopus #0424M by the Worl d Health Organizati on. I 999. Coll ection of 28 monographs covering the qua li ty control and traditional and Rhi zoma Seu Radix Notopterygii (Qianghuo) Notopte rygium #0424N cli ni cal uses of medicin al plants selected fo r incl usion on the Radix Angelicai (Danggui) #0424 P basis of th eir widespread use, particula rly in countries th at rely heavily on medi cin al plants to meet primary health care Radix Angeli cai Dahuricae (Baizhi ) #0424Q needs. Aims to encourage standardized Radix Ligustici Chuanxiong (Chuanxiong) #0424 R scientific approaches to ensu ring the safety, $82 80 qua li ty, and eflicacy of medici nal plants and Pericarpiu m Zanthoxyli (Huajiao) #0424S their products. Softcover, 287 pp. Ite m #428 each WHO Monographs on Selected Medicinal $12 All 17 monographs$185 (Save over l 0%) #04241 Plants, Vol. 2 American Herbal Pharmacopoeia Monographs Item #428A • Compre he ns ive review of the the rapeutic uses • Complete safety a nd toxicology data • C ritical info rmatio n o n side e ffects, contra indications, all Fitoterapia as pects of qua li ty control, historical use a nd more • Astragalus, Re is hi and S c hisandra a lso include Extensive monographs and literature reviews from Fitoter Traditio na l Chinese M edic ine suppleme nt section apia, a leading international botanical research journal, founded by Iodena, the leading European supplier of • Ashwagandha includes Ay u rvedic supple me nt section botanical derivatives. • Fully refere nced a nd peer reviewed by inte rna tio nal a uthorities Bilberry VaccUulun myrtillUJ 26 pp. Item #425A St. J ohn 's Wort #5420 Ginkgo Ginkgo hiloha 48pp. #4258 Hawthorn Leaf with Flower #426 Astragalu s Root #43 1 Grape Vili.J ••inifera 25 PP· #425C Hawthorn Berry #430 Horse Chestnut k .JculuJ bippol'a.Jfanum 28 PP· #4250 Valeri an Root #427 $19?a~ Milk Thistle Silyhwn f1Ulrianum 39 PP· #425E Schisandra Be rry #434 St. John's Wort Willow Bark #433 Pumpkin Cucur6ila ~po II PP· #425F Ashwagand ha Root #435 Pygeum Prunu.J africatUI 14 PP· #425G 9 Black Haw Ba,·k #436 $9 ?ach Saw Palmetto &renoa rrpcrLi 14 PP· #425H Chaste Tree Fruit #437 St. John's Wort Hy~ricum ~iforalum 25 PP· #4251 Cramp Bark #438 All 17 monographs Reishi Mushroom #439 Valerian ValeriniUl afficiiUIW 13 PP· #425J Goldenseal #440 50 Stinging Nettle UrricaJioica 16pp. #425L $305 Bilberry #44 1 ( I 0% discoou n t) Black Cohosh Rhizome #442 Item #450 $1 0 each $98 for allll Item #425K Cranberry Fruit #443 Dang C ui #445 w w w. H E RBALGRAM.oR G 3 B 0 0 K S ,.._,__ The Desktop Guide to Complemen pies and foundations for the practice Cancer Research ~.....:: tary and Alternative Medicine: an of phytotherapy; in-depth and Natural Compounds In Cancer 1--- - -t Evidence-Based Approach Ed. by detailed profiles of over 45 herbs, '·~'1!~[(~':~~0'> Therapy: Promising Nontoxic Anti Edzard Ernst, Max Pittler, Clare Stevin reviewing pharmacology, research, tumor Agents from Plants and son, and Adrian White. 200 1. Offers and traditional use; therapeutics for Other Natural Sources by John Boik. concise information on 64 popular actual disease states, supported by 2001. Presents a solid scientific basis CAM diagnostic methods and treat- case histories; and coverage of chal for the use of natural compounds in •- ments; summarizes clinica l trial data lenging iss ues such as dosage, safety, and drug ----- cancer treatment. Includes in-depth on the effectiveness of CAM for 38 specific condi herb interactions. Fully referenced with more than discussions of ca ncer at the cellular level and the tions; weighs the benefits and risks of each CAM 4,000 citations. Hardcover, 643 pp. $82.95. #8441 level of the organism, as well as clinical considera treatment; and includes a CD-ROM of the book that tions covering trace metals, vitamin C and antioxi links to Medline. Softcover,444 pp. $36.95. #B50 1 Consumer Education dants, polysaccharides, lipids, amino acids and Evidence-Based Herbal Medicine by Jungle Medicine by Con ni e Graud s. related compounds, fl avonoids, nonflavonoid Michae l Rotblatt, MD, and Irwin 2001. Story of the author's spiritual phenolic compounds, terpenes, lipid-soluble vita Ziment, MD. 2002. Analyzes a la rge journey from being strictly a western mins, and the effects of natural compounds on quantity of the primary literature on pharmacist, through her experiences chemotherapy and radiation therapy. Soft cover, 52 1 controlled clinical trials and provides with an Amazonian shaman, to her pp. $32. #8494 reliable and practical information on rebirth as a shamana who combines the uses, pharmacology, efficacy, and her knowledge of western medicine Clinical/Therapeutic adverse effects of approximately 65 with what she lea rned in the jungle to herbal medicines and a few non-herbal dietary The Clinician's Handbook of Natural form a new spirited medicine. Softcover, 206 pp, supplements. Softcover, 464 pp. $29. #B5 16 Medicine by Joseph Pizzorno Jr., $14.95.#B514 n:~i Michael Murray, and Herb Joiner-Bey. Herbal Medicine by Rud olf Fritz NATURAL Making Plant Medicine by Riche 2002. Provides an easily accessed set Weiss, M.D. 2000. 2nd Edition. The MEDIGNE Cech. 2000. Th e medici ne making of decision-making flowcharts and now cla ssic text used by M.D.s in section includes: drying and process summary information based on Germany. An indispensable modern ing herbs; making tinctures the easy the best avai lable evidence on text in medical herbalism. Many way; the mathematics of tincturing natural medicine options, includ- herbs are illustrated. Pl ant drugs are and solubility factors; basic formulas ing herbs, su pplements and dietary advice. Covers arranged by clinica l diagnoses relat for fresh and dry extraction, including 74 common diseases and includes scientifically ve ri ing to particular systems. Softcover, dosages; vinegar extract s, glycerites, fied therapies. Softcover, 522 pp. $39.95. #B506 362 pp. $59. #B006 herbal succi and syrups; teas, decoctions, herbal -=- ~ Delmar's Integrative Herb Guide for Herbal Medicine- Classic Edition by oils, sa lves and creams; poultices, compresses and .:..#.. · Nurses by Martha Libster, MS, RN . Rudolf Fritz Weiss, M.D. 2000.Thi s is a soaks; and a section with more than 100 herbs that \ ~~~ 2002. Profi les 58 common herbs and key text in the field of phytotherapy, are readily cultiva ted in North America. The listings II E H B · conditions they treat. Incl udes the used by both herbali sts and medical incl ude conservation status, parts used, specific C lJ II>I ·~· latest biomedical research and clini professionals. Arranged by clinical formula s, practical uses, dosages, contraindications For N~ cal practice information and 4 and an overview of altern ate species. Softcover, 282 ~ diagnoses rel ated to organ system s, ~~ practical information on how to inte- with guidelines for presc ribing pp. $14.95. #B490 ~ r - grate plant-based therapies into herbal remedies, sections on dosa ge, application lll ONE EARTH The One Earth Herbal Sourcebook: patient care. Extensive cu ltural information and precautionary measures. Proprietary formula Hffii\\L! Quality Control Methods for Medici PDR for Nutritional Supple PDR for Herbal Medicines 2nd nal Plant Materials by the World ments, 1st edition. 2001 . Provides edition. 2000. Updated to include Health Organization. 1998. A collec detailed information on each the latest scientific findings, clini tion of recommended test procedures nutritional supplement including cal trials (including abstracts), for assessing the identity, purity, and clinical research summary; scien case reports, and meta-analysis content of medicinal plant materials tific and common names; chemi results. More detailed monograph intended to support development of ii~!ili cal and physical attributes; indica- sections on herb/drug interaction national standards based on local tions and usage; pharmacology and pharmaco side effects, contraindications, precautions, market conditions. Includes macroscopic and kinetics; precautions, adverse reactions and adverse reactions, and dosage. Hardcover, 858 microscopic exa mination, thin-layer chromatogra contraindications; potential interactions with pp. $59.95. #8474 phy, and tests for determination of many factors. drugs, food, alcohol, and herbs; and dosage and Softcover, 11 5 pp. $31.50. #B406 administration. Hardcover, 575 pp. $59.95. #8500 1-800-373 - 7105 • www.HERBAlGRAM.oRG 5 HERBALGRAM One of the great benefits of Membership in the American Botanical Council The Journal of the American Botanical Council " In my opinion, Herbal Gram if the be.1t .1ource avaiLabLe on aLL a.1pect.1 of phytomedicine, cLinicaL data, hi:1toricaL information, LegaL and regulatory .1tatu..1, nwrket report.1, and more. " - Michael Flannery, Associate Director for Historical Coll ections, Lister Hill Library for the H ealth Sciences, University of Alabama at Birmingham Slipcases Protect and store valuable back issues! O ne slipcase holds one BackPack Volume. Item # 55 0C [lli_RBAIGRAM HerbalGram Sample At all levels of membership, you wi ll / The current iss ue of the highl y-acclaimed peer receive a new issue of HerbalGram four reviewed journal. Item #CURR times each year. See appl ication on page 2 of this issue of HerbalGram. nn BackPacks Volume II Volume III Volume IV Herba!Gram back issues enhance your Herba!Gram issues Herba!Gram issues Herba!Gram issues library of information on herbal issues, #18/19-33 #34-49 #50-56 books, research, conferences, laws, and (1989-1995) (1995 to 2000) (2000 to 2002) related topics. The BackPacks are a set of Item #5508 Item #5500 Item #550E Herba!Grams from 1989 through the $4000 $4000 second most current issue. Special Offer All three back packs, 2 slipcases and index. 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