MEDLINE-based assessment of animal studies on Chinese herbal medicine

Ethno-pharmacological relevance

The scientific proof and clinical validation of Chinese herbal medicine (CHM) require a rigorous approach that includes chemical standardization, biological assays, animal studies and clinical trials.

Aim of the study

To assess the experimental design of animal studies on the activity of CHM by selection and scrutinizing of a series of papers in some major disease areas.

Materials and methods

We have analyzed the English publications reported in MEDLINE (ISI web of knowledge).

Results

Our data showed that (i) research of CHM during the last 10 years had been highly intensified and become more accessible worldwide through increased publications in English, although still most authors had Chinese names; (ii) English journals publishing animal research of CHM were comparable to those publishing animal studies of non-Chinese phytotherapy in terms of impact factor; and (iii) published data on authentication and quality control of CHM, as well as research design of animal studies were far from sufficient to meet the criteria needed to support their reproducibility and reliability.

Conclusions and perspectives

The recent decade witnessed an increase in CHM research activities and CHM English publications. Based on common problems identified in publications on CHM animal studies, we have proposed a checklist that could help in preliminary selection of publications lacking the most common problems and thus would be useful for a quick search of reproducible CHM regimens that are likely to be effective in a given context. The second application of this checklist is to help avoid the most common problems when designing experiments.     

Traditional Chinese medicine research in the post-genomic era: good practice, priorities, challenges and opportunities

Background and aims

GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GP-TCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions.

Materials and methods

Literature studies, opinion polls and discussions among consortium members and stakeholders.

Results

By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials.

Conclusions

The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012.     

Chinese herbal medicine-derived compounds for cancer therapy: A focus on hepatocellular carcinoma

Ethnopharmacological relevance

Hepatocellular carcinoma (HCC) as the major histological subtype of primary liver cancer remains one of the most common malignancies worldwide. Due to the complicated molecular pathogenesis of HCC, the option for effective systemic treatment is quite limited. There exists a critical need to explore and evaluate possible alternative strategies for effective control of HCC. With a long history of clinical use, Chinese herbal medicine (CHM) is emerging as a noticeable choice for its multi-level, multi-target and coordinated intervention effects against HCC. With the aids of phytochemistry and molecular biological approaches, in the past decades many CHM-derived compounds have been carefully studied through both preclinical and clinical researches and have shown great potential in novel anti-HCC natural product development. The present review aimed at providing the most recent developments on anti-HCC compounds derived from CHM, especially their underlying pharmacological mechanisms.

Materials and methods

A systematic search of anti-HCC compounds from CHM was carried out focusing on literatures published both in English (PubMed, Scopus, Web of Science and Medline) and in Chinese academic databases (Wanfang and CNKI database).

Results

In this review, we tried to give a timely and comprehensive update about the anti-HCC effects and targets of several representative CHM-derived compounds, namely curcumin, resveratrol, silibinin, berberine, quercetin, tanshinone II-A and celastrol. Their mechanisms of anti-HCC behaviors, potential side effects or toxicity and future research directions were discussed.

Conclusion

Herbal compounds derived from CHM are of much significance in devising new drugs and providing unique ideas for the war against HCC. We propose that these breakthrough findings may have important implications for targeted-HCC therapy and modernization of CHM.     

Clinical research on traditional drugs and food items—the potential of comparative effectiveness research for interdisciplinary research

Ethnopharmacological relevance

In the traditional context, herbs are often used as herbal whole system therapies, however, most clinical trials included highly selected patients and applied standardized treatment protocols with the aim to exclude as much bias as possible. These studies have contributed important information on the efficacy of herbal medicine extracts; however, their results are only marginally helpful to understand the value of herbal medicine and food items in a more traditional usual care context.

Methods

The new development of comparative effectiveness research (CER) will be introduced and synergies with ethnopharmacology will be outlined.

Results

CER provides great opportunities for guiding researchers and clinicians in improving management of disease. CER compares two or more health interventions in order to determine which of these options works best for which types of patients in settings that are similar to those in which the intervention will be used in practice. CER uses a broad spectrum of methodologies including randomized pragmatic trials that can also be applied to herbal whole system therapies. Ethnopharmacological research can provide highly relevant information for CER including data on characteristics of typical patients as well as traditional usage including methods of collection, extraction, and preparation. Recommendations for future research on traditional herbal medicine and food items are (1) a systematic cooperation between ethnopharmacology and clinical researchers and (2) a call for more CER on traditional herbal medicines and food items.

Conclusion

Multiple stakeholders, including ethnopharmacologists, should cooperate to identify relevant study questions as well share their knowledge to determine the optimal placement of a clinical trial in the efficacy–effectiveness–continuum.     

Chinese herbal medicine for subacute thyroiditis: a systematic review of randomized controlled trials

Objective

To evaluate the effectiveness and safety of Chinese herbal medicine (CHM) in the treatment of subacute thyroiditis.

Methods

Randomized controlled trials found in PubMed, Cochrane Library, and three Chinese databases were selected. RevMan 5.2 software was used to analyze the data with relative risk or mean difference, expressed with 95% of confidence interval. The quality of trials was assessed and graded the quality of evidence with GRADE profiler software.

Results

Twenty one studies were included. CHM was superior to Western Medicine (include prednisone and NSAIDs) in abating fever, relieving thyroid pain, recovering blood sedimentation, improving thyroid function, and preventing hypothyroidism (P<0.05), while no statistical differences were found in eliminating goiter and reducing relapse rate. CHM plus Western Medicine were superior to Western Medicine in abating fever, relieving thyroid pain, eliminating goiter, and reducing relapse rate, while no statistical differences (P>0.05) were found in recovering blood sedimentation and improving thyroid function. The incidence of adverse reactions in treatment group was lower than that in control group (relative risk was 0.12 and 95% confidence interval was 0.03-0.51). The methodological quality of trials is generally poor with a high risk of bias.

Conclusion

CHM (particularly CHM combined with Western Medicine) used to treat subacute thyroiditis may improve clinical symptoms and signs, reduce relapse rate, and alleviate the side effects of hormones. Due to poor methodological quality of included trials, further more high-quality studies are warranted to confirm the effectiveness and safety of CHM.     

Chinese herbal medicine in treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis

Aim of study

There are multimodal and multidisciplinary approaches to treat diabetic peripheral neuropathy (DPN). However, the intractable adverse effects limited their widespread use. Chinese herbal medicine (CHM) is increasingly used for the treatment of DPN. The aim of this study was to review existing evidence on the effectiveness of CHM for the treatment of DPN.

Materials and methods

Searches were performed with Medline, Embase, Cochrane Central Register of Controlled Trials, CNKI, CBM and Wangfan databases. Controlled trials comparing CHM with other medicine for the treatment of DPN were analyzed.

Results

Eighteen trials met the inclusion criteria. All trials used vitamin B12 and/or B1 as control. Clinical therapeutic effect, divided by three grades including marked effective, effective and ineffective according to the improved degree of subjective symptom, tendon reflex, and nerve conduction velocity, was the only end point reported in all trials, and thus evaluated. The results showed CHM treatment was associated with a superiority in marked effective (odds ratio [OR], 2.40; 95% confidence interval [CI]: 0.94 to 2.97; p<0.001), and effective (OR, 1.39; 95% CI: 1.16 to 1.67; p<0.001). Patients who received CHM treatment was associated with a less likely to report ineffective (OR, 0.26; 95% CI: 0.21 to 0.33, p<0.001). No adverse events were reported in any of the included trials.

Conclusions

According to the pooled results of our study and the poor quality of the included trials, it might be uncertainty that there was a superiority of CHM for treating DPN. More rigorous controlled trials are required to substantiate or refute these early findings.     

Efficacy of Chinese herbal medicine for lumbar disc herniation: a systematic review of randomized controlled trials

Objective

This is a review of the effects of Chinese herbal medicine (CHM) used alone to treat lumbar disc herniation (LDH).

METHORDS

A literature search of the following electronic databases from their inception to February 2013 was conducted: Chinese Biomedical databases, Chinese National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Cochrane Library, Web of Science, MEDLINE, and EMBASE. Randomized controlled trials where CHM had been used to treat LDH were selected. Data extraction, quality assessment, and data analysis were carried out by two independent reviewers.

Results

Of the 2415 studies identified, eight with complete data on 1146 patients were selected. The methodological quality was poor in all trials. Five studies reported that CHM was better than Western Medicine [OR=2.81, 95% CI (1.27, 6.18); OR=3.34, 95% CI (1.92, 5.79); OR=2.22, 95% CI (1.08, 4.57); OR=6.67, 95% CI (1.34, 33.28); and OR=1.94, 95% CI (1.23, 3.06)]. Two studies reported that the clinical outcome was better in CHM groups than in physiotherapy and placebo groups, [OR=3.02, 95% CI (1.08, 8.46); and OR=2.67, 95% CI (1.26, 5.64), respectively], whereas one study reported no difference between CHM and physiotherapy groups. One study reported that CHM resulted in higher Japanese Orthopedic Association scores [MD=7.78, 95% CI (6.67, 8.89)] than in a control group and another that participants treated with CHM had lower Visual Analogue Scale scores [MD= − 0.72, 95% CI (− 0.86, − 0.58)] than those in a control group. Three studies reported that the adverse effects of CHM and Western Medicine did not differ significantly [OR=0.10, 95% CI (0.01, 1.85); OR=0.19, 95% CI (0.01, 4.07); and OR=0.07, 95% CI (0.00, 1.32)].

Conclusion

CHM may be more effective than other interventions for LDH; however, methodological weaknesses in the studies assessed in this review prevent a definitive conclusion. More high-quality large-scale studies are required to clarify this matter.     

A strategy for evaluating antipyretic efficacy of Chinese herbal medicines based on UV spectra fingerprints

Ethnopharmacological relevance

Quality analysis and control of Chinese herbal medicines (CHM) or herbal medicines (HM) are being more and more investigated based on fingerprint analysis, and there are also some researches on correlating fingerprints of CHM to their efficacy. Multi-component analysis methods together with fingerprints are considered potential useful tools to select candidate herbal drugs from extracts of herbs in pharmacological/bio-prospecting investigations.

Aim of the study

To explore a strategy for evaluating efficacy strength of CHM samples based on their spectra fingerprints and validate it.

Methodology

Radix bupleuri (RB), a typical Chinese medicinal herb for relieving exterior syndrome, and Flos lonicerae (FL), Fructus forsythiae (FF), and Radix isatidis (RI) that are widely applied Chinese herbs for heat clearing and detoxifying, were selected as herbal sources. The aqueous extracts, volatile oils and mixtures of the extracts and oils of the four herbs, plus Ibuprofen suspension (IS), Shuanghuanglian oral liquid (SHL), mixture of SHL and the volatile oils of FL and FF, were used for subject samples to do antipyretic experiments on rats. Ultraviolet spectra were used as the spectra fingerprints to represent chemical characteristics of the samples. Principal component analysis (PCA) and canonical correlation analysis (CCA) were adopted as evaluation tools to establish the correlation between pharmacological and spectra data, from which a spectral index for evaluating antipyretic effects of CHM samples was constructed. Furthermore, four compound samples were designed by mixing 50% volatile oils and 50% aqueous extracts of the four herbs with different ratios to validate the strategy.

Results

Efficacy sequence of the 15 calibrating and 4 validating CHM samples, defined by the first canonical correlative variable U₁ of their UV spectra, was consistent with that given by pharmacological experiments.

Conclusions

The strategy proposed in this study could be applied to evaluate efficacy strength of CHM and helpful for screening candidate herbal drugs from different herbs or prepared by different technologies.     

Classification and reduction manipulation of fractures in Chinese traditional Mongolian osteopathy

Objective

To explore the concept of classification and reduction manipulation of fractures in Chinese traditional Mongolian osteopathy.

Methods

Based on the linear classification of fractures in Chinese traditional Mongolian osteopathy and the practice of reduction manipulation, a dynamic classification and reduction manipulation concept of fractures was established with the use of modern biomechanical principles and methods.

Results

We classified the linear classification and reduction manipulation of fractures in Chinese traditional Mongolian osteopathy based on the achievement of fracture line and used the cause of the formation of the fracture line for our dynamic classification and reduction manipulation of fractures concept.

Conclusion

The etiology of the formation of fracture lines can be used to decrease diagnostic error, increase therapeutic effects of manipulation, and further provide a new concept and method for the development of the reduction concept of fractures.     

New finding of an anti-TB compound in the genus Marsypopetalum (Annonaceae) from a traditional herbal remedy of Laos

Ethnopharmacological relevance

There is widespread use of traditional herbal remedies in the Lao PDR (Laos). It is common practice to treat many diseases with local plants. This research project documented and analysed some of these traditional remedies used to treat symptoms of tuberculosis (TB).

Materials and methods

This research was executed by interviewing healers about plants used traditionally to treat the symptoms of TB. Samples of some of the plants were collected, and extracts of 77 species were submitted to various in vitro assays in order to determine the amount of growth inhibition of virulent Mycobacterium tuberculosis H37Rv (Mtb), as opposed to other microbes and mammalian Vero cells.

Results

Interviews took place with 58 contemporary healers in 5 different provinces about plants currently used, giving a list of 341 plants. Bioassay-guided fractionation was performed on Marsypopetalum modestum (Pierre) B. Xue and R.M.K. Saunders (Annonaceae), leading to the isolation of dipyrithione, an anti-mycobacterial compound isolated for the first time from the genus Marsypopetalum through this research.

Conclusions

This research has helped to increase awareness of Laos’ rich diversity of medicinal plants and will hopefully provide incentive to preserve the undeveloped forested areas that remain, which still hold a wealth of medical information for future discoveries.     

Akupunktur und Schmerz – eine Historie in 3 Teilen: Teil 2: Der Weg der Akupunktur in die moderne Schmerztherapie

Background

In modern pain therapy, a more integral view on the patient has become prevalent. Interdisciplinary approaches for diagnosis and treatment have become established, especially regarding patients suffering from chronic pain. Besides the application of conventional pain medicine, alternative therapy options are being implemented. Here, especially acupuncture has become important since it emphasizes the unity of body, mind, and soul.

Aim

The historical evolution of the integration of acupuncture into pain therapy as well as the scientific knowledge regarding this therapeutic approach will be explained.

Methods

Extant literature about the development of pain therapy, acupuncture techniques, as well as results of basic research was interpreted in the context of daily clinical practice.

Results

Considering the changes that pain therapy experienced over the last century, the integration of acupuncture into increasingly important interdisciplinary treatment approaches appears almost as a logical consequence. The bio-psycho-social model representing the basis of modern pain therapy emphasizes the interrelation of pain syndromes and purely physical factors, the patient's life situation, and social background, in the same way as done in acupuncture therapy. In this context, the development of western acupuncture styles besides the traditional Chinese techniques is of special interest.

Discussion

The summary of the historical and scientific background of acupuncture and pain medicine reveals that interdisciplinary therapy and, especially the integral point of view represent relatively new approaches. Thus, further progress in the treatment of chronic pain patients can be expected.     

Fighting fire with fire: poisonous Chinese herbal medicine for cancer therapy

Ethnopharmacological relevance

Following the known principle of “fighting fire with fire”, poisonous Chinese herbal medicine (PCHM) has been historically used in cancer therapies by skilled Chinese practitioners for thousands of years. In fact, most of the marketed natural anti-cancer compounds (e.g., camptothecin derivatives, vinca alkaloids, etc.) are often known in traditional Chinese medicine (TCM) and recorded as poisonous herbs as well. Inspired by the encouraging precedents, significant researches into the potential of novel anticancer drugs from other PCHM-derived natural products have been ongoing for several years and PCHM is increasingly being recognized as a gathering place for promising anti-cancer drugs. The present review aimed at giving a rational understanding of the toxicity of PCHM and, especially, providing the most recent developments on PCHM-derived anti-cancer compounds.

Materials and methods

Information on the toxicity and safety control of PCHM, as well as PCHM-derived anti-cancer compounds, was gathered from the articles, books and monographs published in the past 20 years.

Results

Based on an objective introduction to the CHM toxicity, we clarified the general misconceptions about the safety of CHM and summarized the traditional experiences in dealing with the toxicity. Several PCHM-derived compounds, namely gambogic acid, triptolide, arsenic trioxide, and cantharidin, were selected as representatives, and their traditional usage and mechanism of anti-cancer actions were discussed.

Conclusions

Natural products derived from PCHM are of extreme importance in devising new drugs and providing unique ideas for the war against cancer. To fully exploit the potential of PCHM in cancer therapy, more attentions are advocated to be focused on their safety evaluation and mechanism exploration.     

Study on Traditional Chinese Medicine theory of lung being connected with large intestine

Objective

The theory of lung being connected with large intestine, which is a major topic in Traditional Chinese Medicine (TCM), has guided clinical practice for thousands of years in China.

Methods

In this study, we analyzed the history, main contents, clinical application, and material basis of the theory, to attempt to improve the potential clinical significance of “lung being connected with large intestine” in China.

Results

The lung being connected with large intestine was first described in “Huang Di Nei Jing”, and formed one of the basic theories of TCM. For thousands of years, the majority of TCM practitioners explored this theory continuously, leading to its development and use as an important theory in the guidance of TCM clinics In the last decade, researchers in the field of integrated TCM and Western medicine have studied clinical applications and biomedical mechanisms with experimental methods to explore the implications of the theory.

Conclusion

With the further development of science and technology, research concerning the theory of lung being connected with large intestine will be greatly stimulated and contribute to the modernization of TCM.     

Good practice in reviewing and publishing studies on herbal medicine, with special emphasis on traditional Chinese medicine and Chinese materia medica

Ethnopharmacological relevance

Studies on traditional Chinese medicine (TCM), like those of other systems of traditional medicine (TM), are very variable in their quality, content and focus, resulting in issues around their acceptability to the global scientific community. In an attempt to address these issues, an European Union funded FP7 consortium, composed of both Chinese and European scientists and named “Good practice in traditional Chinese medicine” (GP-TCM), has devised a series of guidelines and technical notes to facilitate good practice in collecting, assessing and publishing TCM literature as well as highlighting the scope of information that should be in future publications on TMs. This paper summarises these guidelines, together with what has been learned through GP-TCM collaborations, focusing on some common problems and proposing solutions. The recommendations also provide a template for the evaluation of other types of traditional medicine such as Ayurveda, Kampo and Unani.

Materials and methods

GP-TCM provided a means by which experts in different areas relating to TCM were able to collaborate in forming a literature review good practice panel which operated through e-mail exchanges, teleconferences and focused discussions at annual meetings. The panel involved coordinators and representatives of each GP-TCM work package (WP) with the latter managing the testing and refining of such guidelines within the context of their respective WPs and providing feedback.

Results

A Good Practice Handbook for Scientific Publications on TCM was drafted during the three years of the consortium, showing the value of such networks. A “deliverable – central questions – labour division” model had been established to guide the literature evaluation studies of each WP. The model investigated various scoring systems and their ability to provide consistent and reliable semi-quantitative assessments of the literature, notably in respect of the botanical ingredients involved and the scientific quality of the work described. This resulted in the compilation of (i) a robust scoring system and (ii) a set of minimum standards for publishing in the herbal medicines field, based on an analysis of the main problems identified in published TCM literature.

Conclusion

Good quality, peer-reviewed literature is crucial in maintaining the integrity and the reputation of the herbal scientific community and promoting good research in TCM. These guidelines provide a clear starting point for this important endeavour. They also provide a platform for adaptation, as appropriate, to other systems of traditional medicine.     

Traditional knowledge on medicinal plant of the Karen in northern Thailand: A comparative study

Ethnopharmacological relevance

We studied traditional medicinal plant knowledge among the Karen in northern Thailand.

Aim of the study

To compare traditional medicinal knowledge in 14 Karen villages in northern Thailand and determine culturally important medicinal plant species in each Karen village.

Materials and methods

We interviewed 14 key informants and 438 non-specialist informants about their traditional knowledge of medicinal plants. We tested normality of the data and correlations with distance to the nearest city using Kolmogorov–Smirnov tests and Spearman's rank correlation coefficient. Cluster analysis and cultural importance index (CI) were calculated for the similarity of medicinal plant used and culturally importance medicinal plant species among Karen villages respectively.

Results

In total 379 medicinal plant species were used. Number of medicinal plants used positively correlate with distance to the nearest city. Relatively low similarities of medicinal plant species and different CI values for species among the different areas were found.

Conclusions

Traditional medicinal plants still play an important role in medicinal practice of the Karen. Local environments, availability of medicinal plant and distance between Karen villages and the nearest city affect the amount of traditional medicinal knowledge in each Karen village. The medicinal plants in this study with high CI values might give some useful leads for further biomedical research.     

The effect of Chinese herbal medicine on non-biliogenic severe acute pancreatitis: A systematic review and meta-analysis

Ethnopharmacological relevance

More and more clinicians and researchers have realized that clinical trials are necessary to define clinical efficacy effect. Even though the number has been substantially growing for the past years, the finished and reported trials are limited. Nevertheless, those documented trials are important and precious, and comprehensive evaluation and analysis of them are warranted at current stage. Our goal was to evaluate the effect of Chinese herbal medicine (CHM) on non-biliogenic severe acute pancreatitis (SAP) by conducting a systematic review and meta-analysis of prospective randomized controlled studies.

Methods

Relevant studies were identified by PubMed, Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure Databases (CNKI), and Wanfang database up to 2014.Reference lists of retrieved articles were also reviewed. Two reviewers independently assessed studies for inclusion and extracted data. The main outcome data of trials were analyzed by using RevMan5.2. Odds ratio (OR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. Either a fixed or a random-effect model was used to evaluate the effect of CHM on non-biliogenic SAP.

Results

Twenty two prospective randomized controlled studies involving 1388 participants were included in the meta-analysis. CHM was tested to be more effective than reference group: Mortality [OR: 0.43, 95% CI (0.29, 0.64)], overall efficiency [OR: 4.0, 95% CI (2.72, 5.89)], operability [OR: 0.313, 95% CI (0.21, 0.46)], rate of complications [OR: 0.37, 95% CI (0.27, 0.50)], Length of hospitalization [MD: −9.70, 95% CI (−12.88, −6.51)] compared with reference group.

Conclusions

No serious adverse events were reported. This meta-analysis provides evidence suggesting that CHM seems to be an effective and safe treatment for people with non-biliogenic severe acute pancreatitis (SAP). However, the poor methodological quality of most of the trials means that we may be unable to reach a definitive conclusion. Hence, the effect of CHM in the treatment of non-biliogenic SAP warrants rigorously designed, multicentre, large-scale trials with higher quality worldwide.     

Triptolide: Progress on research in pharmacodynamics and toxicology

Ethnopharmacological relevance

Tripterygium wilfordii Hook. f. (Tripterygium wilfordii), also known as Huangteng and gelsemium elegan, is a traditional Chinese medicine that has been marketed in China as Tripterygium wilfordii glycoside tablets. Triptolide (TP), an active component in Tripterygium wilfordii extracts, has been used to treat various diseases, including lupus, cancer, rheumatoid arthritis and nephritic syndrome. This review summarizes recent developments in the research on the pharmacodynamics, pharmacokinetics, pharmacy and toxicology of TP, with a focus on its novel mechanism of reducing toxicity. This review provides insight for future studies on traditional Chinese medicine, a field that is both historically and currently important.

Materials and methods

We included studies published primarily within the last five years that were available in online academic databases (e.g., PubMed, Google Scholar, CNKI, SciFinder and Web of Science).

Results

TP has a long history of use in China because it displays multiple pharmacological activities, including anti-rheumatism, anti-inflammatory, anti-tumor and neuroprotective properties. It has been widely used for the treatment of various diseases, such as rheumatoid arthritis, nephritic syndrome, lupus, Behcet?s disease and central nervous system diseases. Recently, numerous breakthroughs have been made in our understanding of the pharmacological efficacy of TP. Although TP has been marketed as a traditional Chinese medicine, its multi-organ toxicity prevents it from being widely used in clinical practice.

Conclusions

Triptolide, a biologically active natural product extracted from the root of Tripterygium wilfordii, has shown promising pharmacological effects, particularly as an anti-tumor agent. Currently, in anti-cancer research, more effort should be devoted to investigating effective anti-tumor targets and confirming the anti-tumor spectrum and clinical indications of novel anti-tumor pro-drugs. To apply TP appropriately, with high efficacy and low toxicity, the safety and non-toxic dose range for specific target organs and diseases should be determined, the altered pathways and mechanisms of exposure need to be clarified, and an early warning system for toxicity needs to be established. With further in-depth study of the efficacy and toxicity of TP, we believe that TP will become a promising multi-use drug with improved clinical efficacy and safety in the future.     

What is “clinical data”? Why and how can they be collected during field surveys on medicinal plants?

Ethnopharmacological relevance

“Reverse pharmacology”, also called “bedside-to-bench” or “field to pharmacy” approach, is a research process starting with documentation of clinical outcome as observed by patients with different therapeutic regimens. The treatment most significantly associated with cure is selected for future studies: first, clinical safety and efficacy; then in vivo and vitro studies.Some clinical data, i.e. details on patient status and progress, can be collected during ethnobotanical surveys; they will help clinical researchers and, once effectiveness and safety are established, will also help users of traditional medicine make safer and more effective choices. To gather clinical data successfully, ethnopharmacologists need to be backed by an appropriate team of specialists in medicine and epidemiology. Ethnopharmacologists can also gather important data on traditional medicine safety.

Materials and methods

The first step is to create a consensus on the meaning of “clinical data”, their interest and importance. An understanding of why “a cure is not a proof of effectiveness” is a starting point to avoid faulty interpretation of the clinical observations.

Results

Experience showed that, with the “bedside-to-bench” approach, a treatment derived from traditional recipe can be scientifically validated (in terms of safety and effectiveness) with a cost of less than a million euros, thus providing an end-product that is affordable, available and sustainable.

Conclusions

With rigorous clinical study results, medicinal plant users gain the possibility to refine heath strategies. The field surveyor may gain a better relationship with the population, once she/he is seen as bringing information useful for the quality of care in the community.     

Intercultural health and ethnobotany: How to improve healthcare for underserved and minority communities?

Ethnopharmacological relevance

The present conceptual review explores intercultural healthcare—defined as the integration of traditional medicine and biomedicine as complementary healthcare systems—in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy).

Background

Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients' healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested.

Aim of the review

To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities.

Key findings

The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare.

Conclusions

Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of healthcare.