Korean ginseng: Clinical Use

In the scientific arena, ginseng and the various ginsenosides are used in many forms and administered via various routes. This review will focus primarily on those methods commonly used in clinical practice. CANCER PREVENTION The various anticancer actions of Panax ginseng, as demonstrated in animal and in vitro trials, support its use as an agent to prevent the development and progression of cancer. A 5-year prospective study of 4634 patients over 40 years of age found that ginseng reduced the relative risk of cancer by nearly 50%. A retrospective study of 905 case-controlled pairs taking ginseng showed that ginseng intake reduced the risk of cancer by 44% (odds ratio equal to 0.56). The powdered and extract forms of ginseng were more effective than fresh sliced ginseng, juice or tea. The preventative effect was highly significant (P < 0.001). There was a significant decline in cancer occurrence with increasing ginseng intake (P < 0.05). Epidemiological studies in Korea strongly suggest that cultivated Korean ginseng is a non-organ-specific human cancer preventative agent. In case-control studies, odds ratios of cancer of lip, oral cavity and pharynx, larynx, lung, oesophagus, stomach, liver, pancreas, Read more […]

Korean ginseng: Other Actions

PREVENTION OF DAMAGE FROM TOXINS Ginseng extract has been shown to be beneficial in the prevention and treatment of testicular damage induced by environmental pollutants. Dioxin is one of the most potent toxic environmental pollutants. Exposure to dioxin either in adulthood or during late fetal and early postnatal development causes a variety of adverse effects on the male reproductive system. The chemical decreases spermatogenesis and the ability to conceive and carry a pregnancy to full term. Pretreatment with 100 or 200 mg/kg ginseng aqueous extract intraperitoneally for 28 days prevented toxic effects of dioxin in guinea pigs. There was no loss in body weight, testicular weight or damage to spermatogenesis. In guinea pigs Panax ginseng also improves the survival and quality of sperm exposed dioxin. PROMOTING HAEMOPOIESIS Ginseng is traditionally used to treat anaemia. The total saponin fraction, and specifically Rg1 and Rb1, have been shown to promote haemopoiesis by stimulating proliferation of human granulocyte-macrophage progenitors. ANTIOXIDANT In vitro studies did not find various extracts of ginseng to be particularly potent antioxidants against several different free radicals. However, animal models Read more […]

Korean ginseng: Main Actions

Clinical note — Adaptogens Adaptogens are innocuous agents, non-specifically increasing resistance against physical, chemical or biological factors (stressors), having a normalising effect independent of the nature of the pathological state (original definition of adaptogen by Brekhman & Dardymov 1969). Adaptogens are natural bioregulators, which increase the ability of the organism to adapt to environmental factors and to avoid damage from such factor (revised definition by Panossian et al 1999). (Refer to the Siberian ginseng post for more information about adaptogens and allostasis.) ADAPTOGEN The pharmacological effects of ginseng are many and varied, contributing to its reputation as a potent adaptogen. The adrenal gland and the pituitary gland are both known to have an effect on the body’s ability to respond to stress and alter work capacity, and ginseng is thought to profoundly influence the hypothalamic-pituitary-adrenal axis. The active metabolites of protopanaxadiol and protopanaxatriol saponins reduce acetylcholine-induced catecholamine secretion in animal models and this may help to explain the purported antistress effects of ginseng. Ginseng has been shown in numerous animal experiments Read more […]

Korean ginseng: Background

Historical Note Gin refers to man and seng to essence in Chinese, whereas Panaxis derived from the Greek word pan (all) and akos (cure), referring to its use as a cure-all. Ginseng is a perennial herb native to Korea and China and has been used as a herbal remedy in eastern Asia for thousands of years. It is considered to be the most potent Qi or energy tonic in TCM. Modern indications include low vitality, poor immunity, cancer, cardiovascular disease and enhancement of physical performance and sexual function. However, a recent systematic review of RCT found that the efficacy of ginseng root extract could not be established beyond doubt for any of these indications. Common Name Korean ginseng Other Names Ren shen (Mandarin), red ginseng, white ginseng Botanical Name / Family Panax ginseng C.A. Meyer (family Araliaceae) It should be differentiated from Panax aquifolium (American ginseng), Panax notoginseng (Tien chi, pseudoginseng), Eleutherococcus senticosis (Siberian ginseng) and other ginsengs. Plant Part Used Main and lateral roots. The smaller root hairs are considered an inferior source. There are two types of preparations produced from ginseng: white ginseng, which is prepared by drying the raw herb, Read more […]

Goldenseal: Practice Points – Patient Counselling. FAQ

Pregnancy Use Contraindicated in pregnancy and lactation. In addition to the preceding concerns about bilirubin, berberine has caused uterine contractions in pregnant and non-pregnant experimental models. A recent in vivo study using 65-fold the average human oral dose of goldenseal investigated effects on gestation and birth and found no increase in implantation loss or malformation. The authors conclude that the low bioavailability of goldenseal from the gastrointestinal tract was likely to explain the differences between in vitro and in vivo effects in pregnancy. Hydrastine (0.5 g) has also been found to induce labour in pregnant women. Until more pharmacokinetic studies are done, goldenseal is best avoided in pregnancy. Practice Points / Patient Counselling • Goldenseal has been used traditionally as an antidiarrheal agent and digestive stimulant. • It has been used topically as a wash for sore or infected eyes and as a mouth rinse. • Goldenseal is a bitter digestive stimulant that improves bile flow and improves liver function. • Most clinical evidence has been conducted using the chemical constituent berberine. This data has shown effectiveness against diarrhea, congestive heart failure, Read more […]

Goldenseal: Adverse Reactions. Interactions

Clinical note — Berberine absorption Berberine is poorly absorbed, with up to 5% bioavailability. In vitro data has clearly demonstrated that berberine is a potent antibacterial; however, in vivo data has established low bioavailability. Berberine has been shown to upregulate the expression and function of the drug transporter P-glycoprotein (Pgp). Pgp belongs to the super family of ATP-binding cassette transporters that are responsible for the removal of unwanted toxins and metabolites from the cell. It appears that Pgp in normal intestinal epithelia greatly reduces the absorption of berberine in the gut. In vivo and in vitro methods have been used to determine the role of Pgp in berberine absorption by using the known Pgp inhibitor cyclosporin A. Co-administration increased berberine absorption six-fold and clearly demonstrated the role of Pgp in absorption. Increased expression of Pgp can lead to cells displaying multi-drug resistance. As previously reported a certain flavonolignan in many Berberis spp. has the ability to inhibit the expression of multi-drug resistant efflux pumps allowing berberine and certain antibiotics to be more effective. Adverse Reactions Goldenseal is generally regarded as safe Read more […]

Goldenseal: Uses. Dosage

Clinical Use Goldenseal has not been significantly investigated under clinical trial conditions, so evidence is derived from traditional, in vitro and animal studies. Many of these have been conducted on the primary alkaloids. All results are for the isolated compound berberine, and although this compound appears to havevarious demonstrable therapeutic effects, extrapolation of these results to crude extracts of goldenseal is premature. It should also be noted that equivalent doses of the whole extract of goldenseal are exceptionally high. DIARRHOEA A double-blind, placebo-controlled, randomised trial examined the effect of berberine alone (100 mg four times daily) and in combination with tetracycline for acute watery diarrhea in 400 patients. Patients were divided into four groups and given tetracycline, tetracycline plus berberine, berberine or placebo; 185 patients tested positive for cholera and those in the tetracycline and tetracycline plus berberine groups achieved a significant reduction in diarrhea after 16 hours and up to 24 hours. The group given berberine alone showed a significant reduction in diarrhea volume (1 L) and a 77% reduction in cAMP in stools. Noticeably fewer patients in the tetracycline and Read more […]

Goldenseal: Background. Actions

Historical Note Goldenseal is indigenous to North America and was traditionally used by the Cherokees and then by early American pioneers. Preparations of the root and rhizome were used for gastritis, diarrhea, vaginitis, dropsy, menstrual abnormalities, eye and mouth inflammation, and general ulceration. In addition to this, the plant was used for dyeing fabric and weapons. Practitioners of the eclectic school created a high demand for goldenseal around 1847. This ensured the herb’s ongoing popularity in Western herbal medicine, but unfortunately led to it being named a threatened species in 1997. Today, most high-quality goldenseal is from cultivated sources. Common Name Goldenseal Other Names Eye root, jaundice root, orange root, yellow root Botanical Name / Family Hydrastis canadensis (family Ranunculaceae) Plant Parts Used Root and rhizome Chemical Components Isoquinoline alkaloids, including hydrastine (1.5-5%), berberine (0.5-6%) and canadine (tetrahydroberberine, 0.5-1.0%). Other related alkaloids include canadaline, hydrastidine, corypalmineand isohydrastidine. Clinical note — Isoquinoline alkaloids Isoquinoline alkaloids are derived from phenylalanine or tyrosine and are most frequently found Read more […]

Grapeseed extract: Interactions. Precautions. Practice Points

Toxicity Tests in animal models have found grapeseed extract to be extremely. Adverse Reactions Studies using doses of 150 mg/day have found it to be well tolerated. Significant Interactions Controlled studies are not available, therefore interactions are theoretical and based on evidence of pharmacological activity. ANTIPLATELET DRUGS Additive effect theoretically possible — observe patient. ANTICOAGULANT DRUGS Increased risk of bleeding theoretically possible — caution. IRON AND IRON-CONTAINING PREPARATIONS Decreased iron absorption. Tannins can bind to iron, forming insoluble complexes — separate doses by 2 hours. Contraindications and Precautions None known. Pregnancy Use Safety has not been scientifically established. Practice Points / Patient Counselling • Grapeseed extract has considerable antioxidant activity and appears to regenerate alpha-tocopherol radicals to their antioxidant form. • Grapeseed extract also has anti-inflammatory actions, reduces capillary permeability, enhances dermal wound healing and reduces photo-damage, inhibits platelet aggregation and may enhance rhodopsin regeneration or content in the retina. • It is popular in Europe as a treatment forvenous insufficiency Read more […]

Grapeseed extract: Uses. Dosage

Clinical Use Free radical damage has been strongly associated with virtually every chronic degenerative disease, including cardiovascular disease, arthritis and cancer. Clearly, due to the potent antioxidant activity of grapeseed, its therapeutic potential is quite broad. Most clinical studies have been conducted in Europe using a commercial product known as Endotelon®. Due to the poor bioavailability of high-molecular-weight proanthocyanidins, it is advised that products containing chiefly low-molecular-weight PCs be used in practice. FLUID RETENTION, PERIPHERAL VENOUS INSUFFICIENCY AND CAPILLARY RESISTANCE Several clinical studies have investigated the use of grapeseed extract in fluid retention, capillary resistance or venous insufficiency, producing positive results. Hormone replacement therapy and fluctuations in hormone levels can produce symptoms of venous insufficiency in some women. One large study involving 4729 subjects with peripheral venous insufficiency due to HRT showed that grapeseed extract decreased the sensation of heaviness in the legs in just over half the subjects by day 45 whereas 89.4% of subjects experienced an improvement by day 90. According to an open multicentre study of women aged Read more […]