Query: Chinese herbal medicine and narcolepsy

title: On Clinical Development of Traditional Chinese Herbal Medicine
abstract: In recent years, the slowdown of new drug development has resulted in search for alternative medicines such as traditional Chinese herbal medicine (TCM) that can treat critical and/or life threatening diseases in the medical community and pharmaceutical industry. AJHMR CODElthough the development of promising traditional Chinese herbal medicine has great potential, it has been challenged regarding how to effectively and scientifically develop and evaluate a promising TCM under investigation due to the fact that there are some fundamental differences between a Western medicine and a TCM. This article provides a comprehensive review of critical issues that are commonly encountered during the development of a TCM. These issues include, but are not limited to, variation (or consistency) in raw materials, component to component interactions, animal studies, matching placebo and calibration of study endpoints in clinical trials, packaging insert, and transition from experience based to evidence based clinical practice and investigation.

title: Long live Chinese herbal medicine

title: Diagnosis and management of knee osteoarthritis: Chinese medicine expert consensus (2015)
abstract: Literature review shows that Chinese medicine and other related treatment are still the main stream treatment of knee osteoarthritis. Currently, there is short of handbook guiding Chinese medicine from evidence based medical evidence, so it is a top priority to develop a clinical guideline from the expert consensus. After several rounds of discussion during the conference and examination by letter, which has collected opinions from nearly one hundred experts, consensus was reached. Nonpharmacologic interventions include health education, medical exercise, acupuncture, massage, acupotomology, and physiotherapy. Pharmacological interventions are as follows. Topical application includes fumigation, application, hot compressed, ironing and iontophoresis with Chinese herbs, etc. Chinese patent medicine for external use includes plaster, ointment, etc. Western medicine for external use mainly includes emulsion, ointment, plaster and embrocation containing nonsteroidal anti inflammatory drugs (NSAIDs) Intraarticular injection mainly includes sodium hyaluronic acid, chitosan (for injection) with prudent use of glucocorticoid. Chinese herbal medicine and Chinese patent medicine can be taken referring to syndrome differentiation which mainly includes syndromes of qi stagnation and blood stasis, cold dampness, deficiency of Gan (Liver) and Shen (Kidney) deficiency of qi and blood. Western medicine mainly includes analgesic, NSAIDs, diseases modifying drugs. Surgery procedures mainly include joint irrigation, arthroscopic surgery, osteotomy, arthroplasty, etc.

title: Anti inflammatory and antibacterial activities of P. petiolosa (Christ) Ching ethyl acetate extract against S. aureus in mice.
abstract: P. petiolosa as a typical Chinese herbal medicine has been generally utilized as Chinese native medicine formulation for treatment of chronic bronchitis, bronchial asthma and pneumoconiosis. The objective of this study was to evaluate the anti inflammatory and antibacterial activities of P. petiolosa ethyl acetate extract (PPEAE) against S. aureus in mice. The air dried leaves were extracted with ethyl acetate, mice were infected pneumonia by S. aureus. Colonization of S. aureus in lung tissue was calculated by plate colony count. The number of white blood cells (WBC) in blood was measured by blood cell automatic analyzer. The histopathological analysis of hematoxylin eosin staining (H&E) of lung tissue was observed under microscope. Real time PCR assay was employed to determine the relative mRNA expression of HO 1, iNOS and TNF a. The results showed that, compared with control, after treated with PPEAE the wet/dry (W/D) weight ratio of mice lung tissue (decreased from 5.371 to 4.9) and the number of white blood cells (WBC) (decreased by 3.13x109/mL) decreased dramatically. The number of S. aureus was significantly reduced (from 1.93x105 CFU/mL to 26x103 CFU/mL) in lung tissue after treated with PPEAE. Furthermore, H&E staining showed that PPEAE obviously relieved the inflammation of lung tissue of infected mice. Meanwhile, real time PCR results indicated that PPEAE down regulated the expression of inflammatory iNOS, TNF a mRNA and up regulated the expression of anti inflammatory HO 1 mRNA. In summary, this study revealed that application of crude product PPEAE had prominent antibacterial activity against S. aureus. PPEAE significantly reduced the biomass of S. aureus in lung tissue and effectively relieved the inflammation of S. aureus induced pneumonia.

title: Genes Induced by Panax Notoginseng in a Rodent Model of Ischemia Reperfusion Injury
abstract: Stroke is a cerebrovascular disease that results in decreased blood flow. Although Panax notoginseng (PN) a Chinese herbal medicine, has been proven to promote stroke recovery, its molecular mechanism remains unclear. In this study, middle cerebral artery occlusion (MCAO) was induced in rats with thrombi generated by thread and subsequently treated with PN. After that, staining with 2,3,5 triphenyltetrazolium chloride was employed to evaluate the infarcted area, and electron microscopy was used to assess ultrastructural changes of the neurovascular unit. RNA Seq was performed to determine the differential expressed genes (DEGs) which were then verified by qPCR. In total, 817 DEGs were identified to be related to the therapeutic effect of PN on stroke recovery. Further analysis by Gene Oncology analysis and Kyoto Encyclopedia of Genes and Genomes revealed that most of these genes were involved in the biological function of nerves and blood vessels through the regulation of neuroactive live receptor interactions of PI3K Akt, Rap1, cAMP, and cGMP PKG signaling, which included in the 18 pathways identified in our research, of which, 9 were reported firstly that related to PN's neuroprotective effect. This research sheds light on the potential molecular mechanisms underlying the effects of PN on stroke recovery.

title: Guidelines for the Diagnosis and Management of Herb Induced Liver Injury
abstract: Herb induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM) and is now a growing segment of drug induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM, it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM) the authors present an evidence chain based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points suspected diagnosis, clinical diagnosis, and confirmed diagnosis could be reached according to the length of the evidence chain acquired in the structured diagnostic workflow. Either identifying the species of CM or HM or excluding adulterations and toxin contaminants was strongly recommended to improve the level of evidence for a clinical diagnosis of HILI. In addition, the authors report that the improper use of CM, which violates the general law of CM theory, is one of the most important factors that contributes to HILI and should be avoided. By contrast, based on syndrome differentiation, some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore, 9 recommendations are put forward in this guideline.

title: Glycyrrhiza Glabra Linn. "Klitaka" A Review
abstract: Herbal medicines are the synthesis of therapeutic experiences of generations of practising physicians of indigenous systems of medicine for over hundreds of years. Herbs have stood the test of time for their safety, efficacy, cultural acceptability and lesser side effects. Glycyrrhiza glabra commonly known as Yashtimadhu, is a popular herb, which has since long been used in traditional Ayurvedic and Chinese medicine for its magical effects to cure various diseases. This plant is also pharmacologically studied for its antiulcerogenic, antioxidant, antimicrobial, and anti inflammatory properties. This review attempts to highlight the available literature on Glycyrrhiza glabra with respect to its ethnobotany, pharmacognostic characteristics, traditional uses, chemical constituents and summary of its various pharmacologic activities and clinical effects. Other aspects, such as toxicology and precautions are also discussed. This will be helpful to create interest towards licorice and may be useful in developing new formulations with more therapeutic and economical value. SHEETAL VISPUTE M.D. (scholar) Department of Bhaishajya Kalpana, Y.M.T. Ayurvedic Medical

title: Phytotherapy in India: transition of tradition to technology
abstract: The disease preventive and health promoting approach based on herbal medicine takes into consideration, the promotion of health and treating ailments is holistic way and finds increasing acceptability in many regions of the world, India and China being in the forefront. The practice of herbal medicine basically depends on folklore and by experiences of people over a long period of time. However, very little research especially in the area of basic science has been conducted in a systematic manner. Medicinal plants with a long history of safe and effective use are likely to have a pharmaceutical effect. The use of plants in traditional medicine can be explained by physiologically active phytochemical compounds of a species and also by its ascribed meaning in a culture. A Plants produce a great diversity of substances that could be of therapeutic significance in many areas of medicine. However, the chemical nature of plant compounds present naturally as such and in extract, is puzzling. It is important to know constituents of plant extracts and their relative importance in their therapeutic value. The alkaloids and other compounds are characterized and tested for their medicinal value from these plants which include not only the unexplored tribal plants but also the spices, condiments and vegetables which are already in use. In last decade, there is a renewed interest in the development of herbal drugs underlined by the understanding of mechanism of action rather than based on faith and folk, as it happened in past. Several aspects on integrated approaches of drug development from herbs have explored many potential lead phytochemicals. Nonetheless, even the limited number of mechanistic experiments reveals that numerous mechanisms are likely involved in the various actions of even a single herbal medicine. It will be the elucidation of such mechanisms that will provide the scientific basis for establishing the efficacy and safety of not only Chinese and Indian herbal medicines but all forms of medicinal botanicals.

title: Spasmolytic Mechanism of Aqueous Licorice Extract on Oxytocin Induced Uterine Contraction through Inhibiting the Phosphorylation of Heat Shock Protein 27
abstract: Licorice derived from the roots and rhizomes of Glycyrrhiza uralensis Fisch. (Fabaceae) is one of the most widely used traditional herbal medicines in China. It has been reported to possess significant analgesic activity for treating spastic pain. The aim of this study is to investigate the spasmolytic molecular mechanism of licorice on oxytocin induced uterine contractions and predict the relevant bioactive constituents in the aqueous extract. The aqueous extraction from licorice inhibited the amplitude and frequency of uterine contraction in a concentration dependent manner. A morphological examination showed that myometrial smooth muscle cells of oxytocin stimulated group were oval shaped and arranged irregularly, while those with a single centrally located nucleus of control and licorice treated groups were fusiform and arranged orderly. The percentage of phosphorylation of HSP27 at Ser 15 residue increased up to 50.33% at 60 min after oxytocin stimulation. Furthermore, this increase was significantly suppressed by licorice treatment at the concentration of 0.2 and 0.4 mg/mL. Colocalization between HSP27 and a SMA was observed in the myometrial tissues, especially along the actin bundles in the oxytocin stimulated group. On the contrary, the colocalization was no longer shown after treatment with licorice. Additionally, employing ChemGPS NP provided support for a preliminary assignment of liquiritigenin and isoliquiritigenin as protein kinase C (PKC) inhibitors in addition to liquiritigenin, isoliquiritigenin, liquiritin and isoliquiritin as MAPK activated protein kinase 2 (MK2) inhibitors. These assigned compounds were docked with corresponding crystal structures of respective proteins with negative and low binding energy, which indicated a high affinity and tight binding capacity for the active site of the kinases. These results suggest that licorice exerts its spasmolytic effect through inhibiting the phosphorylation of HSP27 to alter the interaction between HSP27 and actin. Furthermore, our results provide support for the prediction that potential bioactive constituents from aqueous licorice extract inhibit the relevant up stream kinases that phosphorylate HSP27.

title: Cocaine and Amphetamines
abstract: The stimulant effects of ephedrine, an alkaloid of the shrub, Ephedra vulgaris, were described in China more than 5000 years ago. Local physicians typically used the plant, also known as ma huang, as a herbal remedy for asthmatic wheezing and other pulmonary problems. These disorders are caused by severe constriction of the bronchial tree, and ephedrine simply relaxes bronchial muscle to improve respiration. Although Western medicine relied on intravenous epinephrine (adrenaline) to treat severe asthma, pharmaceutical firms recognized the value of developing an oral medication for bronchial congestion. By 1935, several ephedrine analogues were synthesized, some of which remain in use as nasal decongestants (e.g. pseudoephedrine) The amphetamines were developed as part of this effort. In fact, the first synthetic ephedrine analogue was a mixture of d and l amphetamine. Marketed in 1932 as a decongestant, these amphetamine isomers were the active ingredient in the popular Benzedrine inhaler, which quickly became known for its stimulant properties. The addition of a second methyl group created an even more potent amphetamine variant, methamphetamine, sold as Methedrine. After the amphetamines became available in tablet form, they were used to treat both narcolepsy, a condition characterized by sleep attacks, and attention deficit hyperactivity disorder (ADHD) an apparent paradoxical effect (see below) Amphetamine tablets also were used as appetite suppressants; d amphetamine was marketed for this purpose as Dexedrine in 1945, but the anorexiant effect faded rapidly