The rise of traditional Chinese medicine and its materia medica: A comparison of the frequency and safety of materials and species used in Europe and China

Ethnobotanical relevance

Due to the global rise in the use of traditional Chinese medicine (TCM), Chinese materia medica (medicinal materials, or CMM) are giving cause for concern over their evidence base, safety/possible toxicity, questionable quality and use of endangered species of both animals and plants. However, little if anything is actually known about the range of species used to produce CMM used in Europe and even in China. This study represents the first attempt to identify and compare the most important CMM used in both regions, to begin the process of assessing the risks to public health and possible future benefits.

Materials and methods

Data were collected from a convenience sample of TCM practitioners in the EU and mainland China, using a paper/online survey. Among other questions, respondents were asked (1) which conditions they most commonly treated using CMM and the likelihood of them using herbal manufactured products and decoctions in addition to raw herbs; (2) the perceived frequency with which they observed adverse events to CMM; (3) the frequency and reasons for use of 1 herbal formula and 6 specific individual herbs; (4) an open question about other CMM they used, including materials of non-plant origin. Data were entered into PASW statistics package and analysed using frequency tables, cross-tabulations and chi-squared tests to compare EU and Chinese results.

Results

From a total of 747 useable questionnaires (420 from China, 327 from the EU) of those responding from the EU, TCM was generally more commonly used for obstetric/gynaecological and dermatological conditions, compared to neurological and gastrointestinal diseases in China. Disorders treated by Chinese practitioners were more varied, and often more serious, than those treated by their European counterparts, and the range of materials used in China was wider. The potential for toxicity was not high in either region, but although greater in China due to the use of more potent CMM, the incidence of side effects was perceived to be higher by EU practitioners.

Conclusions

Very few of the species used to prepare CMM in the EU in this study give rise to safety concerns from what is known from the scientific and other literature, and in China only a few toxic CMM appear to be commonly used, some of them only after processing and mainly for serious disorders. The main cause for concern is likely to be interaction with prescribed medication, especially in central nervous system and cardiovascular conditions where drug interactions have previously been reported most frequently and which would currently be more applicable in China than Europe.     

The causal dependence of present plant knowledge on herbals—Contemporary medicinal plant use in Campania (Italy) compared to Matthioli (1568)

Aim of the study

Plant use has been the subject of many codices, documents and books and still is the subject of many scientific articles, trivial books and brochures. These texts, both historical and recent, exert a strong influence on local plant use, a means of knowledge transmission in particular European studies neglect to consider. Therefore, we determine the causal influence of historical texts on present medicinal plant knowledge using the example of Matthioli (1568) and contemporary ethnobotanical literature from Campania.

Materials and methods

We used Bayesian statistical inference and in particular the Bayesian Additive Regression Trees (BART) model to determine the causal effect of Matthioli on contemporary medicinal plant use in Campania.

Results

The estimation of the average increment of finding a plant species mentioned for a certain use category caused by Matthioli is about 20%, conditionally on the available data. Matthioli's effect is not negligible and lies between 14 and 25% with a high probability.

Conclusions

Studies on contemporary medicinal plant use in Europe over the last two to three decades still include the knowledge of the texts from the Renaissance and the classical writers. To what extent the remaining 80% contain autochthonous knowledge is difficult to assess. Considering the long-lasting effect of Matthioli, more recent books, brochures and newspapers very likely also exerted an influence. As well, television and radio reports on the results of pharmacological and clinical studies and, more recently, the world wide web show an ever-increasing influence.     

Extracts from the Mongolian traditional medicinal plants Dianthus versicolorFisch. and Lilium pumilum Delile stimulate bile flow in an isolated perfused rat liver model

Aim of the study

Dianthus versicolor (Caryophyllaceae) and Lilium pumilum (Liliaceae) are two medicinal plants used in traditional Mongolian medicine to treat hepatic and gastrointestinal disorders. In this study aqueous (AE) and methanolic (ME) extracts of Dianthus versicolor and Lilium pumilum were investigated for their influence on the bile flow. The aqueous extracts of both plants were tested in absence and presence of 10 μM taurocholic acid at three different concentrations (100, 250, and 500 mg/L). The aqueous extract of Dianthus versicolor was further purified in order to locate the active principles. Two resulting fractions, one enriched in flavonoids and the other in sugars, were investigated for their influence on the bile flow in absence of taurocholic acid at 10, 20, and 40 mg/L. The aqueous extracts of both plants were analysed qualitatively by LC-MSⁿ and quantitatively by UV-spectrophotometry.

Materials and methods

The bile flow experiments were performed in the isolated perfused rat liver. The compounds were identified by LC-DAD-MSⁿ and TLC using references. The UV-spectrophotometric analysis was based on the monograph “Passiflorae herba” of the European Pharmacopoeia, and the total flavonoid contents were calculated and expressed as vitexin.

Results

AE and ME of both plants increased the bile flow dose-dependently (between 9% and 30%), and no hepatotoxic effect was seen even during longer perfusions. Stimulation of bile secretion was comparable in the presence and in the absence of taurocholic acid. The flavonoid fraction of Dianthus versicolor increased the bile flow by 18% (p < 0.05) at 40 mg/L, which was comparable to the positive control cynarin. The phytochemical investigations of the Dianthus versicolor AE (total flavonoid content 1.78%) revealed the presence of the isovitexin derivative saponarin. In the AE of Lilium pumilum (total flavonoid content 1.04%) the flavonoids rutoside, kaempferol-3-O-rutinoside, and isorhamnetin-3-O-rutinoside were detected.

Conclusions

The results show that choleresis under extract application is due to a stimulation of the bile-salt-independent bile flow which might be caused by the osmotic power of the extracts (hydrocholeresis). The flavonoids seem to contribute to the bile-flow-stimulating effect of Dianthus versicolor. Both plants exhibit a considerable choleretic effect that contributes to their use in traditional Mongolian medicine against gastrointestinal disorders.     

Gastroprotective effect and cytotoxicity of terpenes from the Paraguayan crude drug "yagua rova" (Jatropha isabelli)

A new jatrophone derivative (6), jatrophone (3), jatropholone A (4) and jatropholone B (5), acetyl aleuritolic acid (1), cyperenoic acid (2) and a monoterpene were isolated from the rhizomes of the Paraguayan crude drug Jatropha isabelli. The compounds were characterized by spectroscopic means. The gastroprotective effect of jatrophone, jatropholone A and B as well as 9beta,13alpha-dihydroxyisabellione 6 and the triterpene 1 was assessed in the HCl/EtOH-induced gastric lesions model in mice. Jatrophone elicited a strong gastroprotective effect with no significant differences between 25, 50 or 100 mg/kg and reducing lesions from 88 to 93%. The jatropholones A and B showed remarkable differences in the gastroprotective assay. Jatropholone A presented a dose-related response, with maximum effect (54% lesion reduction) at the highest dose (100 mg/kg), jatropholone B showed a strong action at all the doses, reducing lesions by 83-91%. The cytotoxicity of the compounds was assessed towards fibroblasts and AGS cells. Jatrophone was toxic against both cell lines (IC50 values: 2.8 and 2.5 microM, respectively). Jatropholone B (5) was not cytotoxic while jatropholone A (4) displayed a selective effect against AGS cells (IC50: 49 microM). The relevance of stereochemistry in the biological effects is clear comparing the effect of jatropholone A and B against AGS cells, with IC50 values of 49 and > 1000 microM for the beta and alpha C-16 isomers, respectively. The results provide scientific support for the use of "yagua rova" as a gastroprotective crude drug in Paraguayan traditional medicine.     

Antioxidant and hepatoprotective effect of swertiamarin from Enicostemma axillare against d-galactosamine induced acute liver damage in rats

Ethnopharmacological relevance

The whole plant of Enicostemma axillare Raynal (Family: Gentianaceae) is used in variety of diseases in traditional Indian system of medicine including hepatic ailments.

Aim of the study

Swertiamarin isolated from Enicostemma axillare Raynal was evaluated for antioxidant and hepatoprotective activity.

Materials and methods

Swertiamarin was isolated from successive ethyl acetate extract of the plant Enicostemma axillare belongs to the family Gentianaceae. The concentration of swertiamarin was determined by high performance thin layer chromatography (HPTLC). The hepatoprotective and antioxidant activity of swertiamarin (100 and 200 mg/kg body weight) was carried out against d-Galactosamine (d-GalN) (200 mg/kg body weight intraperitoneally i.p.) induced liver injury in rats.

Results

Swertiamarin a secoiridoid glycoside was found to contain a major constituent of the extract. d-GalN caused significant hepatotoxicity by alteration of several hepatic parameters. It also caused significant lipid peroxidation and reduced the levels of antioxidant defense mechanisms. The treatment with swertiamarin at 100 and 200 mg/kg body weight when administered orally for 8 days prior to d-GalN caused a significant restoration of all the altered biochemical parameters due to d-GalN towards the normal, indicating the potent antioxidant and hepatoprotective nature of swertiamarin.

Conclusions

Swertiamarin isolated from Enicostemma axillare possesses significant antioxidant and hepatoprotective properties against d-GalN induced hepatotoxicity given at 100 and 200 mg/kg body weight orally for 8 days, which might be due to its in vitro antioxidant activity.     

Hypertensive effects of oral administration of the aqueous extract of Solanum torvum fruits in l-NAME treated rats: Evidence from in vivo and in vitro studies

Ethnopharmacological relevance

Solanum torvum fruits are commonly used in Cameroonian traditional medicine for treatment of arterial hypertension. It has been previously shown that intravenous administration of aqueous extract from dried fruits (AEST) reduced blood pressure.

Aim

The present work evaluates acute toxicity and effects of oral administration of AEST in chronic arterial hypertension induced by l-NAME. Effects of AEST were also evaluated on isolated aorta.

Materials and methods

AEST (200 mg/kg/day, p.o.) was given solely or concomitantly with l-NAME (40 mg/kg/day, p.o.) for 30 consecutive days. Animal body weight, systolic blood pressure and heart rate were measured before stating the treatment and at the end of each week. Urinary volume and urinary sodium and potassium contents were quantified before and at days 1, 15 and 30 of the treatment. Aorta from treated animals was tested for their sensitivity to noradrenalin and carbachol. Aorta from normal untreated rats was used to evaluate the in vitro vascular effect of AEST.

Results

The results showed that AEST did induce neither mortality nor visible signs of toxicity. When given solely or in co-administration with l-NAME, AEST significantly reduced animal's body weight. It amplified the hypertensive and cardiac hypertrophy effect of l-NAME and did not affect these parameters in normotensive animals. AEST increased the sensitivity to noradrenalin in normotensive and significantly reduced it in hypertensive animals. AEST significantly increased urinary volume and sodium excretion in l-NAME treated animals while reducing the sodium excretion in normotensive. In vitro, AEST induced a potent partial endothelium-dependent contraction of aortic ring; contractions that were partially antagonized by prazosin and verapamil and were not relaxed by carbachol.

Conclusion

These results suggest that oral chronic administration of AEST induced potentiation of arterial hypertension and cardiac hypertrophy in l-NAME treated rats. These effects may result from a reduction in sensitivity to vasorelaxant agents and increase in hypersensitivity to contractile factors. AEST possess potent in vitro vasocontractile activity that may result from activation of both α₁-adrenergic pathway and calcium influx.     

Immunomodulatory effects of crude phenylethanoid glycosides from Ligustrum purpurascens

Ethnopharmacological relevance

Ligustrum purpurascens, named as “Ku ding cha”, has been used as a kind of functional tea in southern China for about two thousand years, which has the effects on diuresis, anti-hypertension, weight-loss and anti-inflammation.

The aim of the study

This study was aimed to investigate the immune enhancement effects of the crude phenylethanoid glycosides (CPGs) from Ligustrum. Purpurascens on mice and analyze the chemical profiles of phenylethanoid glycosides in the CPGs.

Materials and methods

The immune functions enhancing potential of CPGs was determined using serum hemolysin antibody, phagocytosis, splenocyte antibody production, and NK cells activity assays. The contents of five major constituents in the crude glycosides of Ligustrum purpurascens were determined by using liquid chromatography, other five glycosides were deduced according to their UV and MS spectra compared with the literature as well.

Results

In the immunizing experiment, mice treated with different doses of CPGs showed an increase (p<0.01) in the haemagglutination titre compared with the control group. The increases (p<0.05) were found to be significant at doses of 440 mg/kg and 1.32 g/kg in the experiments of antibody production of spleen cells, MΦ phagocytosis of chicken RBCs and NK cell activity. Further chemical characterization yielded 10 constituents from CPGs, five glycosides were quantified by HPLC and the structures of other five compounds were speculated according to their UV and MS spectra.

Conclusion

The results suggested that phenylethanoid glycosides from Ligustrum purpurascens have immunomodulatory effects on mice.