chinese herbal medicine

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Last time, I talked about Suan Zao Ren Tang and mentioned some things about the main ingredient, Suan Zao Ren (Sour Date Seed).  I now present to the reader some excerpts from a 2002 study:

Chen, et al.  Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan in 2002. eCAM Advance Access published online on April 1, 2009.
eCAM, doi:10.1093/ecam/nep018 (
http://ecam.oxfordjournals.org/cgi/content/full/nep018)

Let’s go specifically into the part on Suan Zao Ren.

The second most commonly used Chinese herb for subjects with insomnia in our study was Suan-zao-ren (Z. spinosa). It is the chief ingredient in the formula of Suan-zao-ren-tang. In an animal model, Peng et al. (29) reported that Suan-zao-ren had a sedative effect at higher doses and an anxiolytic effect at lower doses. In addition, Zhang et al. (30) indicated that Jujuboside A, one of the components of Suan-zao-ren, produced its sedative–hypnotic effects through effecting the actions of anti-calcium-binding proteins and it inhibited the glutamate-mediated excitatorysignaling pathway in the hippocampus. Jiang et al. (31) also reported that saponins, the main bioactive components of Suan-zao-ren, could prolong the sleeping time induced by barbiturates. In addition, Ma et al. (32) revealed that sanjoinine A, an alkaloid compound of Suan-zao-ren, might regulate GABAergic neurons and further increase the sleeping time and decrease the sleep latency induced by pentobarbital. Notably, there was a case report indicating that Suan-zao-ren could interact with the antidepressant, venlafaxine (Efexor), thereby leading to an acute serotonin reaction (33).

So nice to see that traditional Chinese Medicine is being STUDIED and PROVEN to work.  Here are the research papers cited by Chen et al:

  1. Peng WH, Hsieh MT, Lee YS, Lin YC, Liao J. Anxiolytic effect of seed of Ziziphus jujuba in mouse models of anxiety. J Ethnopharmacol ( 2000;) 72:: 435–41. 
  2. Zhang M, Ning G, Shou C, Lu Y, Hong D, Zheng X. Inhibitory effect of jujuboside A on glutamate-mediated excitatory signal pathway in hippocampus. Planta Med ( 2003;) 69:: 692–5. 
  3. Jiang JG, Huang XJ, Chen J. Separation and purification of saponins from Semen Ziziphus jujuba and their sedative and hypnotic effects. J Pharm Pharmacol ( 2007;) 59:: 1175–80. 
  4. Ma Y, Han H, Eun JS, Kim HC, Hong JT, Oh KW. Sanjoinine A isolated from Zizyphi Spinosi Semen augments pentobarbital-induced sleeping behaviors through the modification of GABA-ergic systems. Biol Pharm Bull ( 2007;) 30:: 1748–53. 
  5. Stewart DE. Venlafaxine and sour date nut. Am J Psychiatry ( 2004;) 161:: 1129–30.

The other herbs in the formula include Chuanxiong, Fuling, Zhimu and Gancao.  The effects of each material seems obvious at first.  From a Chinese pharmacologic point of view, Chuanxiong regulates liver blood and clears blood stasis, Zhu Mu clears deficiency heat and nourishes yin, Gan Cao harmonizes, but what about Fu Ling?  Fu Ling is known for draining dampness, but it should be noted that it enters the Heart meridian as well and thus, has an effect of tranquilizing the mind and calming the spirit.

I had read somewhere that the formula as a whole lowers epinephrine levels, but have yet to find the actual research stating such.

This formula was first noted in Zhang Zhongjing’s “Essentials from the Golden Cabinet”, around 208 AD.  Truly a brilliant man.

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I am a big fan of sleep.  I believe that good sleep is the best medicine, not just laughter.  I would like to write about a patient of mine, a fifty-something male, with complaints of hypertension and insomnia.

I was not the first TCM physician who the patient saw.  He had been given herbs before but his hypertension was still unabated.  When I saw him for the first time, history revealed that he had severe insomnia.  Logic dictates that his hypertension could be due to the lack of sleep.

Acupuncture, however, did not work at all.  I tried the patent remedy Zao Ren An Shen Ye, which helped a bit, but not so much.  Also, his blood pressure was still in the 180/100 range.  Not acceptable to me.

I brought out the heavy artillery.  I decided to use Suan Zao Ren Tang (Sour Jujube decoction).

After three days of taking the formula, the patient followed up.  He is sleeping better and his blood pressure is down to 140/90.  Talk about treating the branch by treating the root!

So what’s so special about Sour Jujube?

wild chinese jujube 300x225 Sour Grapes or Sour Dates?

Wild Chinese Jujube, courtesy foodsnherbs.com

A lot of people know about Da Zao (jujube or red dates) but what about Suan Zao Ren or sour jujube seeds?

Suan Zao Ren is sweet and sour in flavor, meaning it tonifies and preserves yin and fluids.  It’s nature is neutral so it will neither promote nor modulate physiology and inflammation.  It enters the Heart and Liver meridians so it affects the Mind through the Heart and the Qi through the Liver.  Great Chief herb.

Anyway that’s enough for now.  In a few days we will present an analysis of Suan Zao Ren Tang – the formula itself!

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Schistosomiasis is caused by a species of liver fluke that basically plants a flag in the blood vessels in your liver and claims it as it’s own territory.  It can damage internal organs, increase the chances for bladder cancer, and cause retardation of growth and development in children. A brief look at wikipedia (http://en.wikipedia.org/wiki/Schistosomiasis) can give a better overview.

Schistosoma japonicum

Imagine this little bugger in your liver or bladder. Call Ellen Ripley!

A particular problem related to this is the effect that the screwed up circulation in the Portal venous system in the liver leads to hypertension in that portal system and thus, lung problems.

A look at Portal Hypertension: (from www.medicinenet.com) Symptoms include gastrointestinal bleeding, ascites or fluid in the abdomen, mental problems due to liver failure and lung problems, since the blood from the liver goes to the lungs.  This entry deals more with the lung problems.

The actual journal article abstract can be quoted thus :

Portal hypertension is a vascular lesion that initially arises in liver, but structural and functional changes of blood vessels in extrahepatic portal system, systemic circulation and pulmonary circulation also accompany, which now collectively called portal hypertensive vascular lesions. In clinical practice, much attention has been paid to the prevention and treatment of complications such as ascites, esophagogastric variceal bleeding; however the management of pulmonary complications is ignored which affects the prognosis of patients. Hence, drugs used for prevention and treatment of pulmonary complications seem to be very important.

We now find an article (http://www.physorg.com/news186923469.html) entitled “Treatment of portal hypertensive pulmonary lesions induced by schistosomiasis”  Okay, looks interesting, let’s have a go at it!

Calculus Bovis compound preparation can effectively prevent pulmonary complications of portal hypertensive rabbits with schistosomiasis. The successful development of Calculus Bovis and the preliminary study on portal hypertensive pulmonary lesions caused by schistosomiasis suggest that it is of great significance and prospects for further basic and clinical research, development and clinical application of new drugs and preparations to treat portal hypertensive pulmonary lesions induced by schistosomiasis.

I just find it interesting that the chinese name of calculus bovis is not used.  It is Niu Huang, a common ingredient for controlling inflammation.  Famously known as part of the formulas Niu Huang Jie Du Pian (Cow Gallstone Clear Toxicity Pill), An Gong Niu Huang Wan (Calm the Palace Cattle Gallstone Pill) and Niu Huang Qingxin Wan (Cattle Gallstone Clear the Heart Pill), it is famous for rapidly draining fire and clearing inflammation.

To evaluate efficacy of Calculus Bovis compound preparation (ICCBco) in the treatment of lung lesions in portal hypertensive rabbits with schistosomiasis as the experimental animal model, a research group in China performed a randomized, double-blind, controlled trial to observe pathological changes and pathological effect mechanism of expression of fibronectin and laminin in the lung tissue of portal hypertensive rabbits with schistosomiasis.

In vitro cultivated ICCBco is composed of Calculus Bovis, Chinese Paris Rhizome, polygonum cuspidatum, appendiculate cremastra pseudobulb, frankincense, and myrrh, and has the functions of clearing away heat and toxic materials, removing blood stasis, reducing swelling, eliminating blood stasis and promoting tissue regeneration, according to the principle of traditional Chinese medicine. However, the topic has not been unequivocally addressed.

I can’t help it.  Frankincense and myrrh?  I’ve blogged about this before (http://qi-spot.com/2009/12/30/the-wise-mans-gift/) talking about myrrh and it’s benefits for the heart.  Let me elaborate now about blood stasis though, since this is not an easily understood concept for laymen.  Wikipedia, quoting Dan Bensky, sort of got it right thus:

Described in TCM theory as a slowing or pooling of the blood due to disruption of Heart Qi, it is often understood in biomedical terms in terms of hematological disorders such as hemorrhage, congestion, thrombosis, and localischemia (microclots) and tissue changes.

So let’s look at the research from the World Journal of Gastroenterology (http://www.wjgnet.com/1007-9327/16/749.asp)

Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis
Ox Gallstone Cow Bezoar Calculas Bovis 300x254 Cow Gallstones Bowl Over Parasite

Niu Huang or Calculus Bovis - won't kill the bug, but will make you breathe easier

Tao Li, Zhen Yang, Hong-Jiao Cai, Li-Wei Song, Ke-Yu Lu, Zheng Zhou, Zai-De Wu

ISSN 1007-9327 CN 14-1219/R  World J Gastroenterol  2010 February 14; 16(6): 749-754

AIM: To explore the interventional effects and mech­anism of in vitro cultivated Calculus Bovis compound preparation (ICCBco) on pulmonary lesions in portal hypertensive rabbits with schistosomiasis.

METHODS: The experimental group included 20 portal hypertensive rabbits with schistosomiasis treated by ICCBco. The control group included 20 portal hypertensive rabbits with schistosomiasis treated by praziquantel. The morphological changes of the pulmonary tissues were observed under light and electron microscopy. The expression of fibronectin (FN) and laminin (LN) in the lung tissues was analyzed by immunohistochemistry.

RESULTS: Under light microscope, the alveolar exudation in the lung tissue was more frequently observed in the control group, while the alveolar space was fairly dry in the lung tissue of ICCBco group. Under electron microscope, more alveolar exudation in the lung tissue, and more macrophages, alveolar angiotelectasis and the blurred three-tier structure of alveolar-capillary barrier could be seen in the control group. In ICCBco group, fibers within the alveolar interspace slightly increased in some lung regions, and the structure of type Ⅰ epithelium, basement membrane and endodermis was complete, and no obvious exudation from the alveolar space, and novascular con­gestion could be observed. There was a positive or strong positive expression of FN and LN in the lung tissue of the control group, while there was a negative or weak positive expression of FN and LN in ICCBco group.

CONCLUSION: ICCBco can effectively prevent pul­monary complications in portal hypertensive rabbits with schistosomiasis by means of improving lung micro­circulation and lowering the content of extracellular matrix.

In English… well look at the above caption.

Peer review says that it is “interesting research” but “not well planned” – I wish the reviewer were more specific…  It’s a good initial study though for others to use as a stepping stone.

More information: Li T, Yang Z, Cai HJ, Song LW, Lu KY, Zhou Z, Wu ZD. Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis. World J Gastroenterol 2010; 16(6): 749-754. http://www.wjgnet.com/1007-9327/16/749.asp

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Another Biased Headline

“Researcher Warns on Herbal Medicines”

(http://www.abc.net.au/news/stories/2010/02/08/2813236.htm)

Looking at the above headline, what thoughts enter your head?  Obviously it is an attempt to ingrain into the public mind that herbal medicines are dangerous per se.  Sadly, that’s not what the article says.

A forensic pathologist thinks some people’s embarrassment about taking herbal medicines can leave them vulnerable to taking a lethal cocktail of drugs.
Professor Roger Byard of Adelaide University has published a research paper on the dangers of herbal medicines when taken in large quantities, injected or combined with use of prescription drugs.
He has found it can lead to serious illnesses, worsen pre-existing conditions or cause death.
Professor Byard says people are often reluctant to tell their doctor they are taking herbal medicines for fear of ridicule, but it can be a fatal mistake.
Opening sentence: he’s not saying herbal medicines are bad, but that not telling your MD about your use of them can be.  That makes perfect sense because of drug-drug interaction.
“Although obviously a number of herbal substances are quite safe, you don’t know what’s in the package sometimes and there may be interactions, so it is important to talk to your doctor,” he said.
He says his research was sparked by the death of a young man who had injected a Chinese medicine chan su, which contains a toxin from toads.
“The materials that can be added include heavy metals, there’ve been cases of mercury poisoning and arsenic poisoning, lead poisoning, also sometimes the manufacturers will add western pharmaceutical agents, so they’ll add drugs that we manufacture to the herbal medicines to actually increase their effect,” he said.
Note it says that the young man “had injected” not “had been injected with”.  Could this be a case of self-medication?  If so, then he is right again: the message is that herbs can be safe, but some dangerous ones must be administered under the guidance of a qualified practitioner.  That’s something I’ve been saying for years.
Also, be careful of adulterated herbs or herbal products – hence the need for regulation by people who KNOW the herbs.
I generally tell my patients to never get over-the-counter chinese herbal preparations unless a) prescribed by a professional and b) from reliable factories.  If it just says “made in China” it’s probably fake.
Now back to the bias.  Again, the media is subtly manipulating thoughts via headline.  It could easily say “Scientist warns against dangers of abusing herbs.”  Instead, the title seems to imply that herbs are dangerous and that Professor Byard is warning against herbs in general.  In fact, the good Professor is warning against the same thing we do!
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What is so special about Cordyceps? A recent Indian news article says that smugglers attempting to bring Cordyceps sinensis samples into Kashmir have been arrested.  USD 300,000 worth of the materia medica was found – about 90 kg.

Here is the article from bbcnews <http://news.bbc.co.uk/2/hi/south_asia/8375276.stm>

Indian Police Arrest “Caterpillar Mushroom” Smugglers

Police in Indian-administered Kashmir have arrested four people trying to smuggle the rare medicinal herb, caterpillar fungus, to China.

The fungus – known as caterpillar mushroom – is used in Chinese medicine and is believed to be an aphrodisiac.

Police say about 90kg (200lb) of the fungus was seized in the Ladakh region near China. It is worth about $300,000 (£180,000) on the black market.

Caterpillar fungus is found about 5,000m (16,500ft) above sea level.

It must be harvested in freezing monsoon rains in the alpine pastures of the Himalayan mountains around Tibet.

Infertility cure

The fungal parasite – Cordyceps sinensis – infects the larvae of a butterfly and grows inside the body of the insect.

The parasite eventually kills the insect when it becomes a caterpillar and then the fungus grows out of the head of the dead caterpillar.

The power of the fungus was discovered some 1,500 years ago and was used by Ming Dynasty rulers as an aphrodisiac and a cure for infertility.

Recent Chinese studies suggest it also has cancer-fighting and cholesterol-lowering properties.

So far so good – talking about the life cycle.  However, I feel a bit more information is needed, especially to explain why this materia medica is so valuable.  I mean, yeah, it’s hard to find in nature (although it’s not rare and endangered like the tiger)

According to http://tcm.health-info,org, Cordyceps is sweet in flavor and warm in nature.  This means that it is nourishing in general and mildly stimulates the immune system.

strengthen kidneys, tonify yang – impotence, sore/weak back

-tonify kidney yang, nourish lung yin, transform phlegm

-cough, wheezing, bleeding, Xiao Ke

The “aphrodesiac” function stated by bbcnews isn’t right on the dot.  Cordyceps is used to strenghten the kidneys.  The Kidneys in Chinese medicine house Essence, and control reproduction.  Deficient kidneys result in menstrual problems or sperm problems.  I can see how it can be considered an “aphrodisiac” but to label Cordyceps as ONLY that is doing it an injustice.

“Xiao ke” is actually the Chinese term for diabetes, which at stages can be considered as problems of the Lung and Kidneys (and Spleen), which are collectively in charge of water metabolism.

Cordyceps sinensis

Cordyceps sinensis

Also Used For:

Orally, Dong Chong Xia Cao / Cordyceps is used for strengthening the immune system, for reducing the effects of aging, promoting longevity, treating lethargy, and improving liver function in people with hepatitis B. It is also used to treat coughs, chronic bronchitis, respiratory disorders, kidney disorders, frequent nocturia, male sexual dysfunction, anemia, heart arrhythmias, high cholesterol, liver disorders, dizziness, weakness, tinnitus, wasting, and opium addiction. It is also used as a stimulant, a tonic, and an adaptogen which is used to increase energy, enhance stamina, and reduce fatigue.

Cordyceps was actually mentioned in a 4th season episode of House, MD.  Dr. House mentions that it can treat cancer “in monkeys”.

I consider cordyceps a wonderful herb – if you can get it wholesale.  As I said, it’s relatively hard to find and is often smuggled.  I had heard that people would increase its weight by inserting paper clips into the caterpillar, therefore increasing product weight and thus, selling price.  Pretty darned sneaky.

However, there are other, long term, cheaper ways to tonify Spleen, Lung and Kidney.  I personally recommend mixing shan yao (chinese yam) into congee.  Bai he (lily bulb), almonds and lotus seeds are also a personal favorite.

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