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Herba Epimedii

Herba Epimedii is a group of related plant species that can be seen in Asia and Europe. Some of these species are used for medicinal purposes. The Chinese call the herb "Yin Yang Huo", or it was translated into "horny goat weed". Originally it was referring to the species of Epimedium brevicornuum Maxim. The other species of the same genus that are included in the same medicinal list by the Chinese are Epimedium sagittatum (Sieb. et Zucc.), Epimedium koreanum Nakai, Epimedium pubescens Maxim., and Epimedium wushanense T.S. Ying. The species of Epimedium acuminatum Maxim was not included in the list although there were suggestions that the species have the same medicinal actions.

The earliest written record of Herba Epimedii as a medicinal herb is a Chinese Materia Medica called "Shen Nong Ben Cao Jing", which was compiled about 2000 years ago. The herb was classified as medium grade by this early medical work, which means it is either non-toxic or low-toxic herbal medicine that should be applied with care. The herb is harvested in the seasons of summer and autumn; it is interesting to note that in China it is the leaves of the herb are most commonly used and referred to as "Yin Yang Huo", and the roots of the herb are used for slightly different medicinal purposes under different name. The majority of scientific researches on this herb regarding it's safety and medicinal actions are performed in China, Korea and Japan. The results indicate that Epimedium is a rather safe herb with great medical potential.


Medical Use:

Traditionally Chinese uses this herb either alone or in most cases in combination with other different herbs to treat impotence, spermatorrhea, frequent urination, fatigue, forgetfulness, neurasthenia, asthma, osteoporosis, and disorder of heart, Liver, and joints. It is also considered to have anti-aging effect.

Today, the popular Western dietary use of this herb is primarily a single herbal preparation for sex drive boosting and anti-fatigue.


Chemical components:

The main ingredients of the herb are flavone type of compounds, fat, saponins and essential oil.

List:

  • Ceryl alcohol, hentriacontane, phytosterol, palmitic acid, stearic acid, oleic acid, linoleic acid, linolenic acid, bilobanol, magnoflorin, glucose, fructose, icariin, icariside I), Icariside II (epimedoside A).
  • Epimedin A, Epimedin B, Epimedin C, Epimedokoreanoside I, Epimedokoreanoside II, Epimedoside A, I-karisoside A, (quercetin), 4'-methoxy-5-hydroxy-8-3, 3-dimethylallylflavone-3-glucosyl (1--2) rhamnoside-7-glucoside), 4'-methoxy-5-hydroxy-8-3, 3-dimethylallylflavone-3-xylosyl (1--2) rhamnoside-7-glucoside), 4'-methoxy-5-hydroxy-8-3, 3-dimethylallylflavone-3-rham-nosyl (1--2) rhamnoside-7-glucoside.
  • Isoquercetin, icaritin-3-O-α-rhamnoside, hyperin, sagittatoside A, sagittatoside B, sagittatoside C, sagittatin A, sagittatin B, Anhydroicaritin-3-O-α-rhamnoside, Icariside E6, Icariside E7, Icaride A1, Icaride A2, Icariside D3, Icariside H1, Icariside B9.
  • Epimedoside C, baohuoside VI, baohuoside I, rouhuoside.
  • Wushanicariin.

Scientific Researches:

Research has indicated that Herba Epimedii can inhibit acetylcholinesterase (AChE). This shows the herb supports higher levels of the key cholinergic neurotransmitters associated with sexual arousal. The herb also contains some flavonoids, which have estrogen-inhibiting actions, and it's water-extracts has androgen like action. It explains why epimedium has been applied to treat sexual disorder and it was able to boost sex drive for patients with kidney failure in clinical tests.

Icariin, an extract of epimedium shows the effects of osteoblasts stimulation, liver cells protection, and canormalusing cancer cells to act more .

Epimedium also shows the potential of anti-cancer through the inhibition of new blood vessel growths. The water extract of the herb also appear to decrease blood pressure and cholesterol level in animal test.

Safety:

Various animal and clinical tests of Herba Epimedii herb were conducted and so far there was no major side effects discovered.

In one animal toxicity test, the alcohol extract of Epimedium (450 g/Kg) was given orally to mice, and the result indicates there was no toxic reaction. Another toxicity test conducted using acute toxicity, cellular toxicity and genotoxicity experiments including mice bone marrow micro-nuclear test, Ames test and TK gene mutation experiment, shows that all toxicity tests were negative, and the researchers concluded that the herb did not have mutagenic effects. However, it did show some toxic effects on the CHO and CHL cells at high doses. In other animal studies, prolonged use of excessive amounts of Herba epimedii was associated with decreased thyroid activity.

The results of all the studies and tests suggest that Herba Epimedii is a rather safe herb if administered with normal dosage.


References:

1. Yap SP, Shen P, Butler MS, et al. New estrogenic prenylflavone from Epimedium brevicornum inhibits the growth of breast cancer cells. Planta Med 2005;71:114–9.

2. Liao HJ, Chen XM, Li WG. Effect of Epimedium sagittatum on quality of life and cellular immunity in patients of hemodialysis maintenance. Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:202–4.

3. Meng FH, Li YB, Xiong ZL, et al. Osteoblastic proliferative activity of Epimedium brevicornum Maxim. Phytomedicine 2005;12:189–93.

4. Lee MK, Choi YJ, Sung SH, et al. Antihepatotoxic activity of icariin, a major constituent of Epimedium koreanum. Planta Med 1995;61:523–6.

5. Zhao Y, Cui Z, Zhang L. Effects of icariin on the differentiation of HL-60 cells. Zhonghua Zhong Liu Za Zhi 1997;19:53–5.

6. Wang S, Zheng Z, Weng Y, et al. Angiogenesis and anti-angiogenesis activity of Chinese medicinal herbal extracts. Life Sci 2004;74:2467–78.

7. Chen JK, Chen TT. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press, Inc., 2003.

8. Chinese Pharmacology, Beijing, People’s Hygiene Press, 2nd Edition, January, 2006

9. SUI Hai-xia,GAO Peng,XU Hai-bin. The Safety Evaluation of Herba Epimedii Water Extract.

10. National Institute of Nutrition and Food Safety, China CDC, Beijing 100021, 2006.

11. Jiangshu New Medical Institute, The Chinese Medicinal Dictionary, Shanghai, Shanghai Science and Technology Press, 2nd Edition, 2004, P 2250-2253.

12. The Medical University of China, Dictionary of Chinese Medicine, Beijing, Chinese Medical Science and Technology Press, 1997.

13. Xu Guojun, Wang Qing. Colored Illustrations of Chinese Traditional and Herbal Drugs. Fuzhou, Fujian Science and Technology Press, 2nd Edition, 2004.

14. Chinese Pharmacopoeia, 2005 edition

Radix Ginseng

Definition
Radix Ginseng is the dried root of Panax ginseng C.A. Meyer (Araliaceae) (1–5).1

1 Steamed Panax ginseng root is listed in the Japanese pharmacopoeia as "Red Ginseng (Ginseng Radix Rubra)" (2).

Synonyms

Panax schinseng Nees (2).

Other Panax species, including P. quinquefolius L. (American ginseng), P. notoginseng Burk. (San-chi ginseng), P. pseudoginseng Wall. ssp. japonicus Hara = P. japonicus C.A. Meyer (Japanese chikutsu ginseng) and P. notoginseng ssp. himalaicus (Himalayan ginseng) have also been referred to as "ginseng" and used medically (6, 7). However, scientific documentation of these species is insuffi- cient to justify the preparation of a monograph at this time.

Major chemical constituents

The major chemical constituents are triterpene saponins. More than 30 are based on the dammarane structure, and one (ginsenoside Ro) is derived from oleanolic acid (6, 7, 17, 19). The dammarane saponins are derivatives of either protopanaxadiol or protopanaxatriol. Members of the former group include ginsenosides Ra1-3, Rb1-3, Rc, Rc2, Rd, Rd2, and Rh2; (20S)-ginsenoside Rg3; and malonyl ginsenosides Rb1, Rb2, Rc, and Rd. Examples of protopanaxatriol saponins are ginsenosides Re2, Re3, Rf, Rg1, Rg2, and Rh1; 20- gluco-ginsenoside Rf; and (20R)-ginsenosides Rg2 and Rh1. Those considered most important are ginsenosides Rb1, Rb2, Rc, Rd, Rf, Rg1, and Rg2; Rb1, Rb2, and Rg1 are the most abundant. Representative structures are presented below.

http://apps.who.int/medicinedocs/documents/s2200e/p177a.gif

R1

R2

ginsenoside Rb1

O-glc-(1→2)-glc-

O-glc-(1→6)-glc-

ginsenoside Rb2

O-glc-(1→2)-glc-

O-ara(p)-(1→6)-glc-

ginsenoside Rc

O-glc-(1→2)-glc-

O-ara(f)-(1→6)-glc-

ginsenoside Rd

O-glc-(1→2)-glc-

glc-

http://apps.who.int/medicinedocs/documents/s2200e/p177b.gif

R2

R3

ginsenoside Re

glc-

O-rha-(1→2)-glc-

ginsenoside Rf

H-

O-glc-(1→2)-glc-

ginsenoside Rg1

glc-

glc-

ginsenoside Rg2

H-

O-rha-(1→2)-glc-

http://apps.who.int/medicinedocs/documents/s2200e/p177c.gif

http://apps.who.int/medicinedocs/documents/s2200e/p177d.gif

http://apps.who.int/medicinedocs/documents/s2200e/p177e.gif

http://apps.who.int/medicinedocs/documents/s2200e/p177f.gif

Dosage forms

Crude plant material, capsules and tablets of powdered drugs, extracts, tonic drinks, wines, and lozenges. Store in a cool, dry place in well-sealed containers (20).

Medicinal uses

Uses supported by clinical data

Radix Ginseng is used as a prophylactic and restorative agent for enhancement of mental and physical capacities, in cases of weakness, exhaustion, tiredness, and loss of concentration, and during convalescence (21–29).

Uses described in pharmacopoeias and in traditional systems of medicine

Radix Ginseng has been used clinically in the treatment of diabetes (1), but further clinical studies are needed. The drug is also used in the treatment of impotence, prevention of hepatotoxicity, and gastrointestinal disorders such as gastritis and ulcers (1, 7).

Uses described in folk medicine, not supported by experimental or clinical data

Treatment of liver disease, coughs, fever, tuberculosis, rheumatism, vomiting of pregnancy, hypothermia, dyspnoea, and nervous disorders (7).

Pharmacology

Experimental pharmacology

The suggested mode of action of Radix Ginseng is twofold. First, the drug has an "adaptogenic" effect (30), which produces a non-specific increase in the body's own defences against exogenous stress factors and noxious chemicals (31). Secondly, the drug promotes an overall improvement in physical and mental performance (30–33).

Treatment of cultured mammalian cells, isolated organs, and animal models (primarily mice and rats) with Radix Ginseng before or during exposure to physical, chemical, or psychological stress increased the ability of the respective model systems to resist the damaging effects of various stressors (31). These results were demonstrated in cases of radiation poisoning (34–36), viral infection and tumour load (37, 38), alcohol or carbon tetrachloride poisoning (39–41), oxygen deprivation and hypobaric pressure (42, 43), light or temperature stress, emotional stress, and electrical shock or restricted movement (44, 45, 46). The mechanism by which the drug exerts its activity is most likely through the hypothalamus–pituitary–adrenal axis (47–49) and through its immunostimulant effect (50).

Intraperitoneal administration to rats of ginseng saponin fractions or the ginsenosides Rb1, Rb2, Rc, Rd, and Re elevated serum levels of adrenocorticotropic hormone (ACTH) and corticosterone (51, 52). Pretreatment with dexamethasone, which blocks hypothalamus and pituitary functions, prevented ginseng saponin-mediated release of ACTH and corticosterone, and thereby demonstrated that the increase in serum corticosterone by ginseng occurs indirectly through release of ACTH from the pituitary (51, 52).

The immunomodulatory activity of ginseng appears to be at least partly responsible for its adaptogenic effect (50, 53, 54). Alcohol extracts of Radix Ginseng stimulated phagocytosis in vitro, were mitogenic in cultured human lymphocytes, stimulated the production of interferon, and enhanced the activity of natural killer cells (55, 56). Intraperitoneal administration of an extract of the drug to mice stimulated cell-mediated immunity against Semliki Forest virus, elevated antibody levels against sheep red blood cells and natural killer cells (57), and stimulated the production of interferon (58).

Improvement in physical and mental performance has been observed in mice and rats after oral or intraperitoneal administration of the drug (59–63). Oral administration of ginseng saponin fractions to mice increased endurance and prolonged swimming time in swimming tests (63). However, two studies concluded that ginseng had no positive effects on the physical performance in mice and rats (64, 65). The adaptogenic effects of Radix Ginseng are generally attributed to the ginsenosides (66, 67). The ginsenosides have been shown to alter mechanisms of fuel homeostasis during prolonged exercise, by increasing the capacity of skeletal muscle to oxidize free fatty acids in preference to glucose for cellular energy production (59). Other constituents of Radix Ginseng, such as vanillic and salicylic acid, have also been reported to have "antifatigue" activity in rats (68). Furthermore, the antioxidant activity of ginseng was associated with both the ginsenosides and the flavonoid constituents (31, 69). The ginsenosides protected pulmonary vascular endothelium against freeradical- induced injury (69).

Mice given ginseng extract or ginsenosides Rb1 and Rg2 orally during passive avoidance response tests showed an improvement in learning ability which was negatively influenced by stress (30), and rats showed improved retention of learned behaviour (70). Ginsenosides Rg1 and Rb1 are the active nootropic constituents of the drug (66), and improve memory and learning in normal as well as cognition-impaired animals. The mode of action involves an increase in the synthesis and release of acetylcholine, and a decrease of brain serotonin levels (66). In cerebral and coronary blood vessels, extracts of Radix Ginseng produced vasodilatation, which improved brain and coronary blood flow (71). The vasodilatory activity of the ginsenosides appears to be primarily due to relaxation of vascular smooth muscles. The ginsenosides block the constricting effects of norepinephrine in isolated aorta strips, and inhibit the uptake of 45Ca2+ in the membrane and sarcolemma of rabbit heart tissue. Inhibition of Ca2+ uptake in the muscle membrane contributes to the mechanism of vasodilatation (71).

A number of polypeptides and glycans isolated from Radix Ginseng, named GP and panaxans A–E, respectively, have demonstrated hypoglycaemic activity when given intraperitoneally to mice (72, 73). Two of the glycans, panaxans A and B, have been shown to stimulate hepatic glucose utilization by increasing the activity of glucose-6-phosphate 1-dehydrogenase, phosphorylase a, and phosphofructokinase (72). Panaxan A did not affect plasma insulin levels or insulin sensitivity, but panaxan B elevated the plasma insulin level by stimulating insulin secretion from pancreatic islets, and further enhanced insulin sensitivity by increasing insulin binding to receptors (72). The panaxans are not active after oral administration. Administration of GP (intravenously or subcutaneously) to mice or rats decreased blood glucose and liver glycogen levels (73). Radix Ginseng also contains a number of other constituents with hypoglycaemic activity (72, 74). Adenosine, isolated from a water extract of Radix Ginseng, enhanced lipogenesis and cyclic AMP accumulation of adipocytes, and some of the ginsenosides inhibited ACTH-induced lipolysis, suppressed insulin-stimulated lipogenesis, and stimulated the release of insulin from cultured islets (72).

Subcutaneous administration of a ginseng extract enhanced the mating behaviour of male rats (75). The drug further stimulated spermatogenesis in rat (76), and rabbit testes, and increased the motility and survival of rabbit sperm outside the body (75).

Intragastric or intradermal administration of an ethanol extract of the drug to rats decreased histamine-, pentagastrin-, carbachol- and vagal stimulationinduced gastric secretion, and inhibited gastric ulcers induced by stress or by pyloric ligation (77–79).

Liver-protectant activity of ginseng has been demonstrated in vitro and in vivo (80, 81). Intraperitoneal administration of Radix Ginseng extracts to normal and dexamethasone-treated rats did not influence the blood chemistry of normal rats, but it decreased aspartate aminotransferase and alanine aminotransferase levels in dexamethasone-treated animals, thereby demonstrating a liverprotectant effect (81). However, another study demonstrated that an intraperitoneal injection of a methanol extract of Radix Ginseng had no protective activity against carbon tetrachloride-induced hepatotoxicity in rats (82).

Clinical pharmacology

Antifatigue activity

The results of clinical studies measuring increased performance and antifatigue effects of ginseng extracts are conflicting and, in general, most studies suffer from poor methodology, lack of proper controls, and no standardization of the ginseng extracts used. The influence of chronic Radix Ginseng administration (2 g/day orally for 4 weeks) on substrate utilization, hormone production, endurance, metabolism, and perception of effort during consecutive days of exhaustive exercise in 11 naval cadets was reported. No significant differences were observed between the control group and the group receiving the ginseng supplementation (83). Another clinical trial with eight participants reported no significant difference between placebo and ginseng administration during exhaustive exercise after 7 days of treatment (84). A randomized, double-blind, cross-over study sought the effects of ginseng on circulatory, respiratory, and metabolic functions during maximal exercise in 50 men (21–47 years old) (24). Total tolerated workload and maximal oxygen uptake were significantly higher following ginseng administration than with placebo. At the same workload, oxygen consumption, plasma lactate levels, ventilation, carbon dioxide production, and heart rate during exercise were all lower in the ginseng treatment group. The results indicated that the ginseng preparations effectively increased the work capacity of the participants by improving oxygen utilization (24). A placebo-controlled, cross-over study determined the effects of ginseng on the physical fitness of 43 male triathletes (25). The participants received 200mg of a ginseng preparation twice daily for two consecutive training periods of 10 weeks. No significant changes were observed during the first 10-week period, but ginseng appeared to prevent the loss of physical fitness (as measured by oxygen uptake and oxygen pulse) during the second 10-week period (25). Two further studies with athletes given 100 mg of a standardized ginseng extract twice daily for 9 weeks reported significant improvement in aerobic capacity and reduction in blood lactate and heart rates (26, 27), but placebos or controls were not used in either of the two studies. Further extension of these studies using placebo-controlled, double-blind trials demonstrated significant improvement in the ginseng group as compared with the placebo group (28). Similar results were reported in another study on athletes, and the differences between the ginseng and placebo groups lasted for approximately 3 weeks after the last ginseng dose (29). The effects of 1200mg of Radix Ginseng in a placebocontrolled, double-blind cross-over study in fatigued night nurses were assessed and the results were compared with placebo and with effects on nurses engaged in daytime work (22). Ginseng restored ratings on tests of mood, competence, and general performance, and the study concluded that ginseng had anti-fatigue activity (22).

Aqueous and standardized ginseng extracts were tested in a placebocontrolled, double-blind study for immunomodulatory actions (85). Sixty healthy volunteers were divided into three groups of 20 each and were given either a placebo or 100 mg of aqueous ginseng extract or 100 mg of standardized ginseng extract, every 12 hours for 8 weeks. Blood samples drawn from the volunteers revealed an increase in chemotaxis of polymorphonuclear leukocytes, the phagocytic index, and the total number of T3 and T4 lymphocytes after 4 and 8 weeks of ginseng therapy, as compared with the placebo group. The group receiving the standardized extract also increased their T4: T8 ratio and the activity of natural killer cells. The conclusion of this study was that ginseng extract stimulated the immune system in humans, and that the standardized extract was more effective than the aqueous extract (85).

Psychomotor activity

A double-blind, placebo-controlled clinical study assessed the effect of standardized ginseng extract (100 mg twice daily for 12 weeks) on psychomotor performance in 16 healthy individuals (23). Various tests of pyschomotor performance found a favourable effect on attention, processing, integrated sensory–motor function, and auditory reaction time. The study concluded that the drug was superior to the placebo in improving certain psychomotor functions in healthy subjects (23).

Antidiabetic activity

Radix Ginseng has been shown in clinical studies to have beneficial effects in both insulin-dependent and non-insulin-dependent diabetic patients (86, 87). Oral administration of ginseng tablets (200 mg daily for 8 weeks) to 36 noninsulin- dependent patients elevated mood, improved physical performance, reduced fasting blood glucose and serum aminoterminal propeptide of type III procollagen concentrations, and lowered glycated haemoglobin (87).

Impotence

Ginseng extracts improved sperm production in men and may have some usefulness in treating impotence (32). The ginsenosides, which appear to be the active components, are thought to depress blood prolactin levels, thereby increasing libido (32). In one clinical study, 90 patients with erectile dysfunction were treated with ginseng saponins (600 mg orally per day). Treatment improved rigidity, tumescence, and libido, but not the frequency of coitus (88).

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Radix Astragali

Scientific Name

Astragalus membranaceus

Common Name
Huang chi, huang qi, milk vetch,
Radix astragali

Clinical Summary

Astragalus root is widely used in Traditional Chinese medicine for its tonifying properties. Studies done in China suggest that astragalus, when used with angelica, has reno protective effects (6). In addition, astragalus decreases the proteinuria associated with idiopathic membranous nephropathy (7) and exhibits natriuretic action (8). Astragalus may also suppress airway hyper reactivity associated with allergic asthma in vivo (9). It also increases M-cholinergic receptor density in senile rats (11), which suggests that it may have a role in combating senility. Astragalus extract acts as a nerve-growth promoting factor in vitro and in vivo (17), and alleviates obstructive uropathy in mice in combination Angelica sinensis and standard care (18).
An herbal formula containing astragalus as a major ingredient has been shown to reduce fatigue in athletes (10).
Astragalus extracts inhibit tumor growth (5), delay chemical-induced hepatocarcinogenesis in rats (4), and have antiangiogenic property (19). In vitro, animal, and anecdotal human data show that astragalus reduces immune suppression, a side effect of chemotherapy (1) (2), and may also enhance the effects of platinum-based chemotherapy (3).
Conclusions from a meta-analysis suggest benefits of astragalus-based treatments for hepatocellular cancers, but data need to be evaluated in larger, well designed trials (16).
Improvement in quality of life was reported following use of an injectable form of astragalus with vinorelbine and cisplatin in patients with advanced non-small cell lung cancer (NSCLC) (20). However, it is not known whether orally administered astragalus will exert the same effect.

Mechanism of Action

Astragalus works by stimulating several factors of the immune system. The polysaccharides potentiate the immune-mediated antitumor activity of interleukin-2 in vitro , improve the responses of lymphocytes from normal subjects and cancer patients, enhance the natural killer (NK) cell activity of normal subjects, and potentiate the activity of monocytes, increasing phagocytosis perhaps by regulating tumor necrosis factor (TNF) production. The saponins potentiate NK cell activity and restore steroid-inhibited NK cell activity in vitro. They also increase phagocytosis and demonstrate hepatoprotective effects on chemically-induced liver injury in vitro and in vivo. Chinese studies suggest that astragalus, when used with angelica, has renal protective effects by mediating gene expression. Astragalus increases M-cholinergic receptor density in senile rats, suggesting that astragalus may have a role in combating brain senility. An herbal formula containing astragalus can reduce fatigue in athletes by increasing uptake and utility of oxygen .

Adverse Reactions

Adverse effects have not been reported.

Herb-Drug Interactions

  • Immunosuppresants: Astragalus may antagonize the effects of immunosuppressants such as tacrolimus and cyclosporine.
  • Aldesleukin: Concomitant treatment with astragalus has resulted in a 10-fold potentiation of tumor-cidal activity with decreased side effects.
  • Cyclophosphamide: Astragalus may decrease immunosuppression following treatment.

Literature Summary and Critique

Most of the clinical trials on astragalus were conducted in China using multiple-herbal formulas that contain astragalus as the major component. The selection of herbs is based on Traditional Chinese Medicine.

Wu P, Dugoua JJ, Eyawo O, Mills EJ. Traditional Chinese Medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res. 2009 Aug 12;28:112.
This analysis included 45 randomized controlled trials of oral TCM preparations for hepatocellular cancers and involved 3,236 patients. Survival, tumor response, and performance scores were examined. The authors report that products containing ginseng, astragalus and mylabris had a larger treatment effect (OR 1.34, 95% CI, 1.04-1.71, P = 0.01) than the pooled broad estimate. They observed a similar pattern for astragalus-based treatments (OR 1.35, 95% CI, 1.001-1.80. P = 0.048).
Astragalus and other TCM products may be effective against hepatocellular cancers. However, the methodology of trials was poor; all the studies were conducted in China and publication bias in favor of only positive reports is likely. The results should be evaluated in well designed trials.

Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Med Oncol. 2011 Sep 18. [Epub ahead of print]

This study included 136 patients with confirmed non-small-cell lung cancer (NSCLS). Patients were randomized to receive vinorelbine and cisplatin (VC) or VC combined with astragalus polysaccharide APS (VC-APS). Following 3 cycles of treatment, significant differences were observed in overall quality of life (P = 0.003), physical function (P = 0.01), fatigue (P < 0.001), nausea and vomiting (P < 0.001), pain (P = 0.007), and loss of appetite (P = 0.023) between the two groups. Median survival time was 10.7 and 10.2 months (P = 0.76) in VC-APS arm and VC arm, with 1-year survival rates of 35.3 and 32.4% (P = 0.717), respectively.
Astragalus polysaccharide injection combined with vinorelbine and cisplatin may help improve quality of life in patients with NSCLC. However, there was no significant improvement in tumor response or survival rates.

McCulloch M, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: Meta-analysis of randomized trials. J clin Oncol 2006;24(3):419-430.
This analysis sought to determine whether Chinese herbal medicine containing Astragalus increases the effectiveness of platinum-based chemotherapy for advanced non-small-cell-lung cancer. Thirty-four randomized studies involving 2,815 patients were analyzed. Results suggest that when used in conjunction with platinum-based chemotherapy, Astragalus-based medicine improved survival, tumor response, performance status, and reduced chemotherapy toxicity when compared with chemotherapy alone.
However, the low quality of the studies analysed is a drawback and the results are therefore, not conclusive. Well-designed studies are warranted.

Taixiang W, et al. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients (Review). The Cochrane Database Syst Rev 2005; (1):CD004540.
Four clinical trials were included in this review to assess the effectiveness of Astragalus (Huangqi) compounds on the quality of life, side effects of chemotherapy, and on adverse effects in colorectal cancer patients. A decoction of Huangqi compounds was used in combination with chemotherapy in three studies, whereas the fourth study compared Huangqi compounds with two other Chinese herbal formulas. Patients who were given Huangqi compounds experienced a reduction in nausea and vomiting along with a decrease in the rate of leucopenia and an increase in CD3, CD4 and CD8 subsets of T-lymphocytes when compared to those treated with chemotherapy alone in the three studies or with other Chinese formulas in the fourth study.
Use of Chinese herbal medicine along with chemotherapy appears promising for patients with colorectal cancer; however, a major limitation of this review is that it includes only four studies and the studies are of poor quality. Further properly designed trials are needed to confirm these observations.

References

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  2. Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004540.
  3. McCulloch M, See C, Shu XJ, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol. 2006 Jan 20;24(3):419-30.
  4. Cui R, He J, Wang B, et al. Suppressive effect of Astragalus membranaceus Bunge on chemical hepatocarcinogenesis in rats. Cancer Chemother Pharmacol. 2003 Jan;51(1):75-80.
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  6. Yu L, Lu Y, Li J, Wang H. Identification of a gene associated with astragalus and angelica's renal protective effects by silver staining mRNA differential display. Chin Med J (Engl) 2002;115:923-7.
  7. Ahmed MS, Hou SH, Battaglia MC, et al. Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. Am J Kidney Dis. Dec 2007;50(6):1028-1032.
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  16. Wu P, Dugoua JJ, Eyawo O, Mills EJ. Traditional Chinese medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res. 2009 Aug 12;28(1):112.
  17. Lu MC, Yao CH, Wang SH, et al. Effect of Astragalus membranaceus in rats on peripheral nerve regeneration: in vitro and in vivo studies. J Trauma. 2010 Feb;68(2):434-40.
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