Herbal Oral Medicines

The use of herbal medicines has attracted attention in recent years Eollowing the millenary use of natural products worldwide, for instance as teas, their conversion into solid 

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Among the various prerequisites for a perfect quality proof of these herbal drugs, authentication and safety proof take first precedence. Identification was in former times primarily synonymous with the macroscopic and microscopic botanical authenticity. Since that time, however, chemical composition and particularly the complex entities of the low molecular constituents have become of greater interest for oral medicinal application and thus in evaluating the pharmacological effects and therapeutic efficacy of the plant drug extracts obtained by decoction or other extraction processes. 

MATSUMOTO T, YAMADA H (2000) Orally administered Kampo (lapanese herbal) medicine, Juzen-Taiho-To modulates cytokine secretion in gut associated lymphoreticular tissues in mice. Phytomedicine. 6 425-30. 

Ephedrine occurs in various plants and has been used in China for over 2000 years it was introduced into Western medicine in 1924 as the first orally active sympathomimetic drug. It is found in ma huang, a popular herbal medication (see Chapter 64). Ma huang contains multiple ephedrine-like alkaloids in addition to ephedrine. Because ephedrine is a noncatechol phenylisopropylamine (Figure 9-... 

Decoction is the most common form of administration of Chinese herbal medicine. Decoctions are usually taken orally. They can be absorbed quickly and have the strongest action of all of the traditional types of preparation. 

Injections rely on small but precise doses of herbal extracts. They have rapid effects on the body and, unlike orally administered medicines, their therapeutic action is not dependent on the condition of the stomach and intestines. 

Herbal medicine that is administered orally should always be taken warm. If the herbal medicine is a decoction, it should be taken when it is warm herbal medicines that expel wind-cold are better taken hot. If the medicine is a powdered herbal extract, it should be dissolved in boiling water and taken once it has cooled down slightly. 

During treatment, pay close attention to protect the Stomach and Spleen. Not only are these organs the source of the body s Qi and blood, they are also responsible for the absorption of the herbal medicines (when these are administered orally). If the Stomach and Spleen are too weak and sensitive, treatment is more difficult. 

In the UK, the long-term (2 and 6 years) use of Aristolochia species in Chinese herbal mixtures, taken as an oral medication or herbal tea, resnlted in Chinese-herb nephropathy with end-stage renal insnfficiency (1). In reaction to these reports, the erstwhile Medicines Control Agency banned all Aristolochia species for medicinal use in the UK. 

A hospital-based stndy from Oman has snggested that 15% of all cases of self-poisoning seen in this setting are with traditional medicines (9). A case series from Thailand has snggested that in patients with oral sqna-mons cell carcinoma the nse of herbal medicines before the first consnltation with a healthcare professional increases the risk of an advanced stage almost six-fold (10) and snrvey data from the USA have snggested that herb-dmg interactions may be a significant problem in a sizeable proportion of patients (11). 

The use of herbal medicines prepared from the root of Rubia tinctorum (madder) is no longer permitted in Germany. Root extracts have shown genotoxic effects in several test systems, which are attributed to the presence of the anthraquinone derivative lucidin. One of the other main components, alizarin primeveroside, is transformed into 1-hydroxyanthraquinone when given orally to the rat, in which this metabolite has carcinogenic activity (6). 

The main route of exposure of humans and animals to PAs is the oral pathway. Human exposure occurs through consumption of food contaminated by toxic plant products or by the ingestion of herbal medicines containing the toxin. PAs have been found in wheat, milk, honey, herbal medicines, and herbal teas at different concentrations. Livestock exposure to PAs is attributed to the consumption of PA-containing plants while grazing. 

The evasion of formulation and toxicological testing by herbal medicine manufacturers is completely illogical in this context. For example, the Butterbur (or Bog Rhubarb Petasites hybridus) contains well-characterized carcinogens. Butterbur extract tablets are sold as chronic oral therapies... 

Cat s claw (Uncaria tomentosa and Uncaria guianensis), an herbal medicine from the Amazon, is widely used to treat inflammatory disorders. Both species of cat s claw provide effective antioxidant and anti-inflammatory activities, but Uncaria guianensis is the more potent of the two. Non-alkaloid fractions from both species have been found to decrease lipopolysaccharide (LPS)-induced TNF-a and nitrite production in RAW 264.7 cells, and oral pretreatment for 3 days with Uncaria tomentosa actually prevented TNFa mRNA expression and apoptosis. Interestingly, the pharmacological properties of these species do not seem to be dependent on the presence of oxindole or pentacyclic alkaloids [191]. 

The interactions of herbal medicines with P450 3 A4 have already been mentioned and are one of the worst problems with these mixtures . One of the most studied issues is St. John s wort, which induces P450 3A4 as an agonist of the PXR receptor . The induction of P450 3A4 by St. John s wort has been responsible for the loss of the effectiveness of oral contraceptives . The resulting pregnancies... 

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