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PharmAcodynamic Basis of HERBAL MEDICINE SECOND EDITION 7050_book.fm Page ii Wednesday, July 12, 2006 3:27 PM PharmAcodynamic Basis of HERBAL MEDICINE SECOND EDITION Manuchair Ebadi, Ph.D., F.A.C.C.P. Chester Fritz Distinguished Professor of Pharmacology and of Clinical Neuroscience Associate Vice President for Medical Research School of Medicine and Health Sciences University of North Dakota Grand Forks, North Dakota CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2007 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-10: 0-8493-7050-7 (Hardcover) International Standard Book Number-13: 978-0-8493-7050-2 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Ebadi, Manuchair S. Pharmacodynamic basis of herbal medicine / Manuchair Ebadi.--2nd ed. p. cm. Includes bibliographical references and index. ISBN 0-8493-7050-7 (alk. paper) 1. Herbs--Therapeutic use. I. Title. RM666.H33E23 2006 615’.321--dc22 2006043867 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com T&F_LOC_B_Master.indd 1 6/1/06 12:36:35 PM 7050_book.fm Page v Wednesday, July 12, 2006 3:27 PM I dedicate this book to my beloved grandchildren, Jesse Manu Ebadi, Caylin Jane McCormick, Christine Pari McCormick, and Jolie Manizeh Ebadi. 7050_book.fm Page vi Wednesday, July 12, 2006 3:27 PM In books lie the soul of the whole past time, the articulate audible voice of the past, when the body and material substances of it have altogether vanished like a dream. — Thomas Carlyle 7050_book.fm Page vii Wednesday, July 12, 2006 3:27 PM Preface to the First Edition Hippocrates (460-377 B.C.), who used many of the herbal medicines described in this book, lamented, “Life is short, and the art long; the occasion fleeting; experience fallacious; and judgment difficult.” Herbal remedies have become a major component of American health care. Botanicals like ginseng, ma huang, St. John’s wort, and valerian are now household words throughout the world, and the sales of herbal medicine are increasing exponentially. Alternative therapies include acupuncture, energy healing, folk medicines, herbal medicines, homeopathy, massage, and megavitamins, to name only a few. Millions of people in the third world have used and will always use herbal medicines because they believe in them and regard them as “their” medicine, in contrast to the “allopathic” (conventional Western) system of medicine brought in from “outside.” These medicinal herbs are available locally and are prescribed by traditional practitioners of medicine who are part of the community and in whose presence the patient feels comfortable. In Western countries, there is now an increased use of herbal medicines, largely because of a belief that powerful synthetic agents used in Western medicine can exert more unwanted side effects and are too often used indiscriminately and irrationally. Many of our present medicines are derived directly or indirectly from higher plants. Although several classic plant drugs have lost much ground to synthetic competitors, others have gained a new investigational or therapeutic status in recent years. In addition, a number of novel plant-derived substances have entered into Western drug markets. The word pharmacodynamic may be defined as the study of the actions and effects of drugs on organ, tissue, cellular, and subcellular levels. Therefore, pharmacodynamics provides us with information about how drugs bring about their beneficial effects and how they cause their side effects. By understanding and applying the knowledge gained in studying pharmacodynamics, physicians and other members of the health-care delivery team are able to provide effective and safe therapeutic care to their patients. Western physicians prescribing synthetic drugs may want to believe in herbal medicines and use them in their patients, but wish to see scientific documentation as they have learned in their pharmacology and therapeutic courses in medical school. Eastern physicians yearn to find out how their drugs, proven efficacious for thousands of years in ancient civilizations such as Chinese, Indian, Persian, and Egyptian, work and bring about their beneficial effects. This book bridges the past to the present and shows at the molecular level how the herbal medications most often used work. For example: • • • • This book shows how Eastern physicians used meadow saffron, which is good for gout, but also provides evidence that meadow saffron possesses colchicines, an antigoutic medication, and provides the mechanisms of action for it. This book shows how Eastern physicians used belladonna alkaloid for Parkinson’s disease but also provides evidence that belladonna alkaloid contains anticholinergic drugs, which counterbalance the dopamine deficiency syndrome seen in Parkinson’s disease. This book shows how Indians used Rauwolfia serpentina to reduce blood pressure and as an antipsychotic, but also shows that it contains reserpine, which depletes norepinephrine in the periphery bringing about its antihypertensive effects and depletes dopamine in the mesocortical system causing tranquility. This book compares the actions of fluoxetin, the most frequently used antidepressant in the world, with those of St. John’s wort, in altering the uptake of serotonin. 7050_book.fm Page viii Wednesday, July 12, 2006 3:27 PM • • • This book compares the hypnotic and sedative actions of valerian used for thousand years to treat insomnia with those of benzodiazepine derivatives in altering GABAergic transmission. This book describes the existence of drugs isolated from food substances such as horseradish, garlic, and rhubarb, and provides their mechanisms of action. This book describes the efficacy of Shing Jing in male fertility and erectile dysfunction and compares its efficacy with those brought about by levodopa, amylnitrite, vitamin E, and sildenafil (Viagra). The majority of believers in alternative medicine are more educated, but they report poorer health status. They take herbal medicine not so much because are dissatisfied with conventional medicines, but largely because they find these health-care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health care and life in general. M. Ebadi Grand Forks, North Dakota 7050_book.fm Page ix Wednesday, July 12, 2006 3:27 PM Acknowledgments for the First Edition The author expresses his appreciation to Liz Covello, the former publisher of life sciences for CRC Press LLC, and Barbara Ellen Norwitz, the current publisher of life sciences for CRC Press LLC for a gracious invitation to prepare a book on herbal medicine. The author acknowledges the support of Tiffany Lane, editorial assistant, and the magnificent contribution of Gail Renard, production editor, for polishing and refining the book. The author extends his expression of admiration to Debra Jean Kroese, Dawn Halvorson, Lacy Kay Boushee, and HaleyAnn Kroese for gathering reference materials and for typing certain sections of the book. The author remains indebted to Victoria Swift, the director of the art department at the University of North Dakota School of Medicine and Health Sciences for her marvelous artistic talent in completing many of the diagrams; and to Betty Ann Karolski, the associate director, Biomedical Communications Information Technology Services at the University of Nebraska Medical Center for her support in completing this book. The author extends his grateful appreciation and eternal sense of indebtedness to KayLynn Marie Bergland for her magnificent dedication to her job, marvelous work ethics, and incredible skills in typing, reading, editing, proofing, and revising the entire book. The author pays an affectionate tribute and extends his heartfelt gratitude to H. David Wilson, M.D., the eminent Dean and Vice President for Health Affairs, University of North Dakota School of Medicine and Health Sciences, for his unyielding support, Solomonic wisdom, and genuine friendship in facilitating the completion of this book. 7050_book.fm Page x Wednesday, July 12, 2006 3:27 PM 7050_book.fm Page xi Wednesday, July 12, 2006 3:27 PM Preface to the Second Edition Let food be your medicine and medicine be your food. — Hippocrates, 400–377 B.C. Residents of Okinawa, Japan, who eat small portions; of Sardina, Italy, who drink red wine; and of Loma Linda, California, who eat nuts and beans, live longer, are healthier than anyone else on earth (Buettner, 2005), and have some form of spirtual faith. Herbal medicines have been used effectively by ancient Chinese, Egyptian, Hebrew, Indian, Japanese, and Persian cultures in their arts of healing and in sustaining life. The words heal and health mean “whole” or “intact.” In a sense, they are closely connected in meaning — To heal is to make whole, whereas health is the harmonious functioning of one’s body, mind, and spirit. Chronic diseases caused by physical inactivity and inappropriate diet consumption are epidemic in modern Western society. Chronic diseases develop over a lifetime, with clinical sequelae occurring many years after the underlying pathogenesis of the disease has occurred. As we move ahead in the 21st century, cardiovascular diseases (i.e., coronary artery disease, hypertension, stroke, and heart failure), type 2 diabetes, metabolic syndrome, and cancer are the leading killers in Western society and are increasing dramatically in developing nations. Chronic diseases present an enormous burden to society by increasing medical costs and human suffering. Recent data estimate that physical inactivity and poor diet caused 400,000 deaths in the year 2000, ranking second only to tobacco, and it is likely that inactivity and diet will soon rank as the leading cause of death in the U.S. This number may be an underestimate given that it reflects deaths attributable only to those with obesity and physical inactivity. These health problems have been virtually nonexistent in underdeveloped countries, but they are on the rise as people change their diets and become more sedentary. Free radicals (reactive oxygen species and reactive nitrogen species) are implicated in aging and all chronic degenerative diseases. The extent and severity of free-radical damage depends on genetic makeup, current health status, nutrition, and stress level of a person. The body has its own innate ability to counteract free radicals through the production of glutathione and metallothionein, which are two of the most powerful antioxidants. In addition, fresh fruits and vegetables are high in a variety of free-radical-fighting antioxidants. There are also a number of vitamins, minerals, herbs, and food supplements that are known to serve as powerful antioxidants. Among these are vitamins A, C, E, and the mineral selenium. In addition, the flavonoids found in vegetables, berries, citrus fruits, and herbs such as the amla fruit (Emblica officinalis) from India all possess powerful free-radical-fighting antioxidants. Many herbs are high in flavonoids, including Ginkgo biloba, astragalus, hawthorn, green tea, and turmeric, to name a few. Other powerful antioxidants include pycnogenol from grape seed and pine bark, coenzyme Q10, lipoic acid, and N-acetyl cysteine (NAC). Echinacea has been widely used as a herbal remedy for the common cold. An evaluation of Echinacea angustifolia in experimental rhinovirus infections has shown that it has no clinical effects on the infection or the clinical illness that results from it. Reactive-oxygen-species-mediated oxidation of biological molecules are thought to induce a variety of pathological events such as atherogenesis, carcinogenesis, Parkinson’s disease, and even the aging process (which is the progressive accumulation of changes with time associated with or responsible for the ever-increasing susceptibility to disease and death that accompanies advancing age). The aging process may be common to all living things, because the phenomenon of aging 7050_book.fm Page xii Wednesday, July 12, 2006 3:27 PM and death is universal. If so, both aging and the rate of the aging process are under genetic control to some extent, as the manifestations of aging and the life span differs between species and individual members of a species. Furthermore, similar to all chemicals and chemical reactions, the manifestations of aging (which reflect chemical composition) and the rate of the aging process should be subject to environmental influences, including diets. The nature of the aging process has been the subject of considerable speculation. Suggested possibilities include (1) encodement of aging in DNA, (2) progressive breakdown in accuracy in protein synthesis, (3) cross-linkage of macromolecules, (4) “attack” of the immune system on selfantigens in higher organisms, and (5) free-radical reaction damage caused by reactive oxygen species or reactive nitrogen species, which can be attenuated by herbal medicines. Over 90% of the oxygen consumed by a mammal is utilized in the mitochondria. Presumably, the rate of O2 consumption is under genetic control, both nuclear and mitochondrial. It is reasonable to assume that some of the free radicals generated during the reactions involving oxygen, such as the superoxide radical (O–2•), would produce changes in the mitochondria at a rate related to the rate of oxygen consumption. Such alterations in the mitochondrial DNA could have an accumulative deleterious effect on mitochondrial functions, leading to the observed mitochondrial changes in number, morphological characteristics, and enzymatic activity. Thus, the relationship between life span and basal metabolic rate — to a first approximation, constant throughout life — may reflect the overall rate of accumulation of mitochondrial damage secondary to free-radical reactions. Wheat germ containing coenzyme Q10, honey containing choline, and tomato containing lycopene prevent premature aging. The free-radical theory of aging, proposed by Harman (1960, 1981), predicts that a healthy life span can be increased by minimizing deleterious free-radical reactions while not significantly interfering with those essential to the economy of the cells and tissues. The data now available indicates that this can be done by maintaining body weight at a level compatible with a sense of well-being while ingesting diets (that include fruits and vegetables) adequate in essential nutrients but designed to minimize random free-radical reactions in the body. Such diets would contain minimal amounts of components that enhance free-radical reactions, for example copper and polyunsaturated lipids, and increased amounts of substances capable of decreasing free-radical reaction damage, such as α-tocopherol, ascorbic acid, selenium, or one or more synthetic antioxidants. It is reasonable to expect that this approach will decrease morbidity. Several minor compounds in legumes and vegetables have been shown to prevent the peroxidative degeneration of plasma lipoproteins and tissue organelles additively or synergistically with endogenous antioxidants. The major candidates for these dietary antioxidants are phenolic compounds and carotenoids. Many spices such as turmeric and rosemary have been used extensively as natural food additives for flavoring, seasoning, coloring, and antiseptic properties. Several spices are known to exhibit antioxidative activities. Dietary supplementation with turmeric (active ingredient is cuccuminoid) or rosemary (Rosmarinus officinalis L, active ingredients are carnosol and carnosic acid) significantly reduces triacylglycerol and cholesterol contents in the liver. Because triacylglycerol accumulation in the liver is caused by biochemical modification of the mitochondrial and endoplasmic functions, turmeric and rosemary are able to prevent liver disorders, and the said effect is caused by stimulation of hepatic cholesterol-7α-hydroxylase activity. Good nutrition, mostly but not entirely containing vegetables and fruits, and caloric restriction are essential to preventive medicine, and helps one lead a happier and healthier life. The second and extended edition has attempted to retain the topics that readers found informative, deleted or simplified areas that critics considered esoteric, and introduced new subjects. It is the author’s fervent hope that the wisdom of Hippocrates will be heeded, that a wise person should consider health as the greatest of human blessings. M. Ebadi Grand Forks, North Dakota 7050_C000.fm Page xiii Monday, July 17, 2006 10:06 AM Acknowledgments for the Second Edition The author expresses his appreciation to Barbara Ellen Norwitz, the publisher of life sciences for CRC Press, for the gracious invitation to prepare the 2nd edition and to Amber Donley, the project coordinator, for all her assistance in preparing a state-of-the-art compendium on herbal medicine. The author acknowledges the magnificent contribution of Gail Renard, the production editor, for polishing and refining the book. Gail is an extraordinarily perceptive person who is visionary in character, has eagle eyes, is a remarkably intelligent person, and exhibits a Solomonic wisdom in editing scientific works, an attribute which is rarely seen in a production editor. The author remains eternally grateful and in awe of Gail’s judgment and titanic and colossal contributions to restructuring and refining in an admirable fashion four books for him. The author expresses his loving tribute to his two sons John Ebadi, Ph.D. (Oriental medicine and Eastern healing art) and Mark Ebadi, M.D. (Western medicine and Western healing art) for their input on how to bridge past and present medical wisdom, and how to respect not only the immense contributions of many ancient cultures but also the amazing advances made by physicians today in their quests for preventing diseases, prolonging life, and reducing morbidity. The author is indebted to Victoria Swift, the director of the art department at the University of North Dakota School of Medicine and Health Sciences, for her ingenuity of designs and graphic art in completing many of the diagrams. The author is beholden to Cindy Hagen, RN for gathering materials from the world literature to prepare the 2nd edition. The author remains indebted to JoAnn Johnson for being as dependable as the rising sun and the beating heart in completing necessary tasks. The author extends his heartfelt regards and felicitation to Dani Stramer for her devotion, loyalty, and perfectionism in fulfilling all her obligations in a splendid fashion. Her dedication, skill, and determination made the 2nd edition such a great success. It is with affection and gratitude that the author honors his teachers and mentors — Carl B. Camras, M.D., Arnold L. Frizzle, Ph.D., Delta W. Gier, Ph.D., John M. Hamilton, Ph.D., Thomas Hernandez, M.D., Ph.D., Woodbridge O. Johnson, Jr., Ph.D., Robert B. Kugel, M.D., Ernest E. McCoy, M.D., Robert Eli Long, Ph.D., Russell J. Reiter, Ph.D., and Paul M. Scott, Ph.D. — for inspiring him to learn; and salutes his students for encouraging him to teach. The author extends his undying respect to the honorable Byron L. Dorgan, the U.S. senator from North Dakota, and to the honorable John Hoeven, the governor of North Dakota, for extending arms of friendship whenever needed to support the author’s numerous research programs at the University of North Dakota. The author salutes Charles E. Kupchella, Ph.D., the president of the University of North Dakota, Peter Alfonso, Ph.D., the vice president for research at the University of North Dakota, H. David Wilson, M.D., the dean and vice president for health affairs at the University of North Dakota School of Medicine and Health Sciences, Joshua Wynne, M.D, M.B.A., M.P.H., the executive associate dean at University of North Dakota School of Medicine and Health Sciences, and Randy Eken, the associate dean for administration and finance at University of North Dakota School of Medicine and Health Sciences, for their confidence in the author’s talent and supporting him whenever needed. 7050_book.fm Page xiv Wednesday, July 12, 2006 3:27 PM The author remains humbled and in awe of the hundreds of scientists who not only read and made the first edition a best seller but also reviewed the book, lighted the path, and gave direction on how to write the 2nd edition. 7050_book.fm Page xv Wednesday, July 12, 2006 3:27 PM The Author Manuchair Ebadi earned a B.S. in chemistry from Park University (Parkville, Missouri, 1960), an M.S. in pharmacology from the University of Missouri College of Pharmacy (Kansas City, 1962), and a Ph.D. in pharmacology from the University of Missouri College of Medicine (Columbia, 1967). He completed his postdoctoral training in the Laboratory of Preclinical Pharmacology at the National Institute of Mental Health (Washington, D.C., 1970), under the able direction of Erminio Costa, M.D., an eminent member of the National Academy of Sciences. Dr. Ebadi served as chairman of the Department of Pharmacology at the University of Nebraska College of Medicine from 1970 until 1988 and subsequently as professor of pharmacology, neurology, and psychiatry from 1988 through 1999. In July 1999, he was appointed professor and chairman of the Department of Pharmacology and Toxicology at the University of North Dakota School of Medicine and Health Sciences. In September 1999, Dr. Ebadi became professor and chairman of the newly created Department of Pharmacology, Physiology, and Therapeutics; in November 1999, he became professor of neuroscience; and in December 1999, he was appointed associate dean for research and program development. In September 2000, Dr. Ebadi was appointed director of the Center of Excellence in Neurosciences at the University of North Dakota School of Medicine and Health Sciences, and in March 2002, associate vice president for medical research at the University of North Dakota. During his academic career, Dr. Ebadi has received 36 awards, including the Burlington Northern Faculty Achievement Award (1987), the University of Nebraska’s systemwide Outstanding Teaching and Creative Activity Award (1995), and was inducted into the Golden Apple Hall of Fame (1995) for having received 11 Golden Apple awards. He is a member of 18 research and scholarly societies, including Alpha Omega Alpha Honor Medical Society. In 1976, Dr. Ebadi became the Mid-America State Universities Associations (MASUA) honor lecturer; in 1987, he received an award for meritorious contributions to pharmaceutical sciences from the University of Missouri Alumni Association; in 1995, he was honored by a resolution and commendation of the Board of Regents of the University of Nebraska for having developed a sustained record of excellence in teaching, including creative instructional methodology; in 1996, he received the Distinguished Alumni Award from Park University, his alma mater. In November 2002, Dr. Ebadi received a recognition award in appreciation of his outstanding contribution to the UND School of Medicine. In May 2003, Dr. Ebadi received the Outstanding Block Instructor Award for outstanding performance “in the encouragement, enrichment, and education of tomorrow’s physicians.” In 2003, Dr. Ebadi was elected to the prestigious Cosmos Club (Washington, D.C.) for individuals who have distinguished themselves in art, literature, or science. Professor Ebadi discovered and characterized brain metallothioneins isoforms in 1983 and subsequently showed that they are able to scavenge free radicals implicated in Parkinson’s disease. In addition, he showed that metallothionein averts α-synuclein nitration, enhances the elaboration of coenzyme Q10, increases the activity of complex I, enhances the synthesis of ATP, and as an antioxidant is fifty times more potent than glutathione. His research programs have been supported in the past and currently by the National Institute on Aging (AG 17059-06), the National Institute 7050_C000.fm Page xvi Monday, July 17, 2006 10:07 AM of Environmental Health Sciences (NIEHS 03949), the National Institute of Child Health and Human Development (NICHD 00370), the National Institute of Neurological Disorders and Stroke (NINDS 08932, NINDS 34566, and NINDS 40160), and the Office of National Drug Control Policy, Counter Drug Technology Assessments Center (DATM 05-02-C-1252). Dr. Ebadi has written ten books. Pharmacology was translated into Japanese in 1987 (Medical Science International Ltd., Tokyo), Core Concepts in Pharmacology was translated into Chinese in 2002 (Ho-Chi Book Publishing, Taiwan), and Pharmacodynamic Basis of Herbal Medicine (CRC Press, 2002) became a bestseller. In 2005 Dr. Ebadi along with Professor Ronald F. Pfeiffer, M.D., published a book entitled Parkinson’s Disease, which received excellent reviews in JAMA 293, 2281, 2005, and in New England Journal of Medicine 352, 1304, 2005, and won first prize in the neurology category of the 2006 British Medical Association’s Book Competition. On February 26, 2004, Dr. Ebadi received the University of North Dakota Foundation’s Thomas J. Clifford Faculty Achievement Award for Excellence in Research and, on September 7, 2004, he received from President Charles E. Kupchella, the designation of Chester Fritz Distinguished Professor of Pharmacology and of Clinical Neuroscience, the highest honor bestowed by the University of North Dakota. On July 21, 2005, Dr. Ebadi received the Pendelton Honor, from Eugene DeLorme, J.D., Director of Indian Into Medicine Programs; from Dr. David Gipp, President of United Indian Nations; and from Dr. Frank Williams, Vice President of Tribal Board in appreciation of his providing research support for the Indian Nations. Dr. Ebadi has served as a member of the United States Pharmacopoeia Convention since 1970. In February 2006, Associate Vice President Ebadi was appointed Senior Advisor to the President of the University of North Dakota. 7050_book.fm Page xvii Wednesday, July 12, 2006 3:27 PM Introduction The Lord has created medicines out of the earth and he who is wise will not abhor them. — Ecclesiastes, Chapter 38, Verse 4 In all, 120 medicinal plants are found in the Bible including aloe, rue, madder, frankincense, myrrh, and marigold (Calendula officinalis). With its therapeutic efficacy on cough and bronchitis, dyspepsia, liver and gallbladder maladies, and as an appetite stimulant, marigold, known in the Persian language as hamisheh bahar (meaning “always spring”), is a sacred flower and is respected and honored in Eastern religions such as Buddhism, Hinduism, and Taoism. Marigold always follows the sun, needs little care, and gives so much beauty. Hence, it is used as a garland to adorn dignitaries and religious leaders. The saffron-colored robes of the Eastern monks have the color of marigold. Traditional Chinese medicines have developed over a period of at least 5000 years. The earliest known work on Chinese herbs is the Shing Nung Bon Cas Chien, or the herbal classic of the divine plowman. According to this work, Sheng Nung, the divine plowman, tested and recommended a total of 365 herbs — one for each day of the year. The Chinese are proud of their heritage, especially in the uses of natural substances, plants, chemicals, and animal products, and the application of accupuncture. For example, acupuncture performs certain functions in traditional Chinese medicine as follows: • • • • It It It It regulates the flow of chi through channels and organs. removes blockage. strengthens the body’s protective chi. lessens the virulence of excesses. The most sophisticated and state-of-the-art science at the molecular level has shown that acupuncture has the following actions: • • • • It It It It releases pain-killing endorphin and enkephalin. releases immunoenhancing cytokines. releases neurotrophins capable of repairing damaged tissue. suppresses the elaboration and release of inflammatory and necrotizing peptides. Physicians and scientists are beginning to appreciate the therapeutic efficacy of acupuncture. Dr. Ted J. Kaptchuk, who holds a doctorate in Eastern medicine and is the author of a book entitled The Web That Has No Weaver, tells a story about a Chinese peasant who had worked as a maintenance man in a newly established Western missionary hospital. The peasant took some antibiotics from the hospital and treated people in his village who had fever. Many of them were cured. The peasant knew nothing about the pharmacology of the antibiotics, but that was irrelevant; the sick got better. The physicians of yesteryear could not explain the efficacy of acupuncture, but acupuncture worked. The mighty oak tree stands tall and firm in the ground because of its roots. One does not see the roots but they are there. In the last 30 years, significant events occurred that have already produced fundamental changes in the attitude of both the public and scientists toward herbal medicines. These are as follows: 7050_book.fm Page xviii Wednesday, July 12, 2006 3:27 PM • • First, laypersons discovered the utility of whole plant drugs or herbs. Second, dissatisfaction with the effectiveness and especially the cost of modern medicines caused an appreciation of all things “natural” and “organic,” which inspired millions of people throughout the world to gain a deep appreciation for the use of classical plant drugs for the treatment of many ailments. The “green” revolution in terms of herbal medicine has now achieved astonishing popularity in the U.S., although it is not yet encouraged by an ultraconservative Food and Drug Administration that classifies most plant drugs as dietary supplements or food additives, which places severe limitation on labeling. However, in fairness to the FDA, because a plant drug is “natural” does not necessarily mean that it is safe. Primeval humans in search of food undoubtedly experienced much poisoning. We learned by trial and error that eating certain mushrooms, berries, and roots could produce various degrees of gastrointestinal discomfort or death, whereas others could be ingested safely. Certain lessons were learned quickly, and primitive food-gathering humans soon became toxicologists of no mean ability. Eventually, this knowledge was made to work for humans; we prepared arrow poisons from plant extracts to bring down game or foe. We threw crushed leaves of particular plants into water and with little effort quickly obtained a bountiful supply of stupefied fish, and we learned also to wash poison (e.g., cyanide) from a number of common, staple foods to make them edible. It probably took Homo sapiens but a short time to learn how to gather food with relative ease and to participate in the good life. Humans also learned that poisons could be obtained from plants. In classical Rome, for example, mushrooms were the poison of choice and were expertly used by Agrippina, wife of Emperor Claudius and mother of Nero. Agrippina had Lollia Paulina put to death because Claudius, in a careless moment, remarked on Lollia’s beauty. Higher plants were among those studied by Cleopatra in her search for a fatal poison. Using her prisoners and slaves as guinea pigs, she was quite systematic. It was reported that she was not satisfied with the effects of either henbane (Hyoscyamus niger) or belladonna (Atropa belladonna), for they produced too much pain in spite of their rapid actions. She was further disappointed with Strychnos nux-vomica, from which strychnine was eventually extracted. Although its action was instantaneous, it produced convulsions that distorted facial features at death. Finally, she selected the bite of the asp (Egyptian cobra), which produced a serene and prompt death. The FDA could do better, and there is little doubt that consumer demand will promote an everincreasing interest in herbal medicine. Although some plants are poisonous, the majority are not and should be used as therapeutic agents. Alfred North-Whitehead said that “the rejection of any source of evidence is always treason to that ultimate rationalism which urges forward science and philosophy alike.” Practitioners throughout the world have used marijuana. The most sophisticated pharmacological studies have shown for more than two decades that the active ingredients of marijuana are efficacious in the following conditions: • • • • • • • • • Cancer chemotherapy Glaucoma Epilepsy Multiple sclerosis Paraplegia and quadriplegia AIDS Chronic pain Migraine Rheumatic diseases (osteoarthritis and ankylosing spondylitis)