Self-medication with nutritional supplements and herbal over-the-counter products

In recent years,the popularity increased for nutritional supplements and herbal products.Prescription drugs,but not herbal therapies are paid by health insurances.They are sold over-the-counter(OTC)on the patients’own expense.However,there are potential risks of self-medication,e.g.incorrect self-diagnosis,severe adverse reactions,dangerous drug interactions,risk of addiction etc.They are often used by patients at their own discretion without knowledge of and control by their physicians.Certain users are at risk of intoxication.Multiple medications taken by older patients increase the risk for adverse drug reactions,drug-drug interactions,and compliance problems for this age group(polypharmacy).Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants.Herbal preparations may also be carcinogenic or interfere with cancer treatments.Pregnant women use various OTC preparations.However,in many cases,it is unclear whether their use is safe for mother or baby.Self-medication with herbals is also largely distributed among anxious and depressive patients,and patients with other conditions and symptoms.The popularity of herbal products has also brought concerns on quality,efficacy and safety.Cases of botanical misidentification,contaminations with heavy metals,pesticides,radioactivity,organic solvents,microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards.Hepatotoxic effects have been reported for more than 300 plant species,and some commonly used herbs have been demonstrated to interact with Western medication.Health care professionals have a critical responsibility assessing the self-care ability of their patients.Databases are available for pharmacists with information on action,side effects and toxicities as well as herbdrug interactions.There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations(phytovigilance).Physicians,pharmacists,and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs.Information centers for consumers and general practitioners are needed,and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled,double blind and randomized clinical trials.

Animal plant warfare and secondary metabolite evolution

The enduring discussion,why plants produce secondary metabolites with pharmacologically and toxicologically active towards mammals traces back to the eminent role of medicinal plants in the millennia-old history of manhood.In recent years,the concept of an animal plant warfare emerged,which focused on the co-evolution between plants and herbivores.As a reaction to herbivory,plants developed mechanical defenses such as thorns and hard shells,which paved the way for adapted animal physiques.Plants evolved further defense systems by producing chemicals that exert toxic effects on the animals that ingest them.As a result of this selective pressure,animals developed special enzymes,e.g.cytochrome P450 monooxigenases(CYP450)that metabolize xenobiotic phytochemicals.As a next step in the evolutionary competition between plants and animals,plants evolved to produce non-toxic pro-drugs,which become toxic only after ingestion by animals through metabolization by enzymes such as CYP450.Because these sequestered evolutionary developments call to mind an arms race,the term animal plant warfare has been coined.The evolutionary competition between plants and animals may help to better understand the modes of action of medicinal plants and to foster the efficient and safe use of phytotherapy nowadays.

欧洲草药禁令对草药疗法的影响(英文)

The European Parliament and Council enacted a directive on traditional herbal medicinal products (THMPD;Directive 2004/24/EC) as an amendment to an earlier directive on the use of medicinal products(Directive 2001/83/EC) on March 31st, 2004.Since April 30th,2011,all herbal

Diagnosis and Objective Pain Assessment of Traditional Chinese Medicine May Be Useful to Demonstrate Specific Effects of Acupuncture in Low Back Pain: A Prospective, Randomized, Controlled and Single Blinded Pre-study

Objective: To prove specific effects of acupuncture on chronic pain. It was speculated that the potential specific effectiveness of acupuncture could be better shown in more properly designed studies. Therefore, diagnoses of both Western medicine and traditional Chinese medicine (TCM) were used as inclusion criteria to allocate acupoints more precisely to the complaints of the patients. Secondly, objectively measurable parameters of pain relief in addition to usual Visual Analogue Scale (VAS) were chosen to quantify the effects of acupuncture. Methods: The study was prospective, randomized, controlled and single-blinded. Eighteen patients with chronic back pain and TCM diagnosis of a Taiyang/Yangming syndrome received one single session of acupuncture chosen according to TCM diagnosis or acupuncture on points outside the meridian system (controls). We evaluated pain via VAS and increased mobility via inclinometry of the back. Results: Although the sample size was small, there was a statistically significant improvement in pain and mobility in the intervention group (n=13), but not in the control group (n=5). The calculated sample size adequate power was lower for inclinometry than for VAS, indicating that VAS is less probable to discriminate acupuncture effects. Conclusion: Objectively measurable physical parameters such as the angle of flexion before and after acupuncture (inclinometry) may be more suitable to measure pain relief than subjective assessment by VAS in acupuncture studies. TCM diagnosis may be a helpful inclusion criterion in studies on acupuncture, so as to potentially allocate interventions better to the complaints of patients.

Quantification of Acupuncture Effects on Peripheral Neuropathy of Unknown and Diabetic Cause by Nerve Conduction Studies

Objective： To evaluate the effect of acupuncture on peripheral neuropathy （PN） as measured by changes in nerve conduction studies （NCS）. Methods： 192 patients with PN were evaluated over a period of 1 year. In 17 patients diabetic neuropathy was found. 3 of these patients received acupuncture therapy according to classical Chinese medicine as defined by the Heidelberg model of TCM and all improved in NCS. Of the 14 non-specifically treated patients, 3 （21.4%） presented with improved NCS and 11 （78.6%） aggravated in NCS （P〈0.03）. An overall of 47 patients met the criteria for PN of undefined aetiology, 21 patients received acupuncture therapy, while 26 patients received no specific treatment. All groups were examined by NCS before treatment and 4 months later. Results： 1） Diabetic neuropathy, in the control-group 3 patients improved and 11 showed an aggravation. Comparison of groups was significantly different. 2） PN, 16 patients （76.2%） in the acupuncture group improved, while only 4 patients in the control group （15.4%） did so. 3 patients in the acupuncture group （14.3%） showed no change and 2 patients an aggravation （9.5%）, whereas in the control group 7 patients showed no change （26.9%） and 15 an aggravation （57.7%）.Comparison of the groups was significantly different. Conclusion： There is a positive effect of acupuncture on PN, as measured by objective parameters （NCS）.

What is the Role of Chinese Medical Theory in Modern Scientific Research

Defining the classical Chinese diagnosis such as by the Heidelberg model of TCM has shown that outcome of studies is largely dependent on classical diagnostic criteria. The quality of future studies in TCM will largely depend on a variety of factors, such as （1） the classical Chinese diagnosis as an inclusion criterion, （2） objectively measurable parameters as the main criterion of outcome, （3） double blinding of controls. A common understanding of the diagnosis and functional criteria of TCM is therefore necessary, as well as a common understanding of the functional terminology and rationally accessible theory. This underlines the necessity of classical Chinese medical theory for modem scientific research, its proper definition and application in studies.