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The purpose of this bibliography is to provide a brief survey of the literature covering the publication years 1997-1999. This bibliography includes citations from published articles, books, books chapters, and technical reports. Citations to articles in non-English languages are indicated with [ ] around the title. The language is also indicated. Citations are organized under subject categories; General, Adverse Effects, Mechanisms/Pharmacology, Therapeutic Use. Citations have been selected from the TOXLINE database of the National Library of Medicine, National Institutes of Health. The search strategy included terms for the general concept of herbals as well as many specifics.

Naturals, botanicals and minerals. Cosmet Toiletries 1998 Oct;113:81-2, 84, 86, 88, 90-1
IPA COPYRIGHT: ASHP A list of new natural, botanical, and mineral materials for the cosmetic industry, including trade names, properties, claims, applications, and sources, is presented.

Adamolekun B, Hakim JG. Opsoclonus-myoclonus associated with traditional medicine ingestion: case report. East Afr Med J 1998;75(2):120-1.
A case of Opsoclonus-Myoclonus occurring in a young man, in association with traditional herbal medicine consumption is presented. Clinical and laboratory investigations did not reveal any of the known aetiological associations of the Opsoclonus-Myoclonus syndrome, raising the possibility that the traditional herbal medicine may be aetiologically implicated. This report highlights the need for proper identification and documentation of the contents of common herbal remedies and their possible side effects amongst Africans.

Baek NI, Kim JM, Park JH, Ryu JH, Kim SI, et al . Ginsenoside Rs3, a genuine dammarane-glycoside from Korean red ginseng. Arch Pharmacal Res 1997;20(3):280-2.

Balcerska I, Wedzisz A, Uramowski J. [Nitrates and nitrites in selected herbs and herbal preparations]. Bromatol Chem Toksykol 1997;30(2):119-23. (Pol)
BIOSIS COPYRIGHT: BIOL ABS. Several single herbs, herbal blends and granulates were tested for their nitrate and nitrite content. Griess colorimetry was used. All test herbs and preparations were found to contain nitrates and nitrites.

Bao K. Traditional Chinese materia medica (TCMM). Altern Ther Health Med 1997;3(1):18.

Barton BE, Tagat JR. Current status of interleukin-6 inhibitors. Drugs Future 1997 Apr;22:391-5.
IPA COPYRIGHT: ASHP A review of interleukin inhibitors is presented, including biopharmaceuticals such as antibodies, toxic fusion proteins, and peptide antagonists; synthetic chemicals; and miscellaneous compounds such as botanical extracts, marine extract, and tretinoin (retinoic acid).

Borkowski B. [Herbal drugs used in atherosclerosis--antisclerotica]. Farm Pol 1998;54(10):435-47. (Pol)

Bull SS, Melian M. Contraception and culture: the use of yuyos in Paraguay. Health Care Women Int 1998;19(1):49-60.
The use of herbs (yuyos) as contraception is common practice in Paraguay. This report analyzes data from the 1995-1996 Paraguayan Reproductive Health Survey. The analysis reveals that women are more familiar with yuyos (88%) than any other method of family planning. Modeling the determinants of ever having relied on yuyos as contraception demonstrates that older women (OR = 1.043) and women with more children (OR = 2.283) are significantly more likely to have used yuyos, but an interaction between older women with more children shows they are less likely to have used this method (OR = .982). Women living in rural areas (OR = .664) and those with more education (OR = .883) are less likely to have used the method. These findings show widespread acceptance and use of yuyos for contraception in Paraguay. More research into the chemical properties of yuyos is needed to determine their contraceptive efficacy and to prevent harmful effects from their misuse.

Chan TY. Monitoring the safety of herbal medicines. Drug Saf 1997;17(4):209-15.
Extremely limited knowledge about the ingredients in herbal medicines and their effects in humans, the lack of stringent quality control and the heterogenous nature of herbal medicines all necessitate the continuous monitoring of the safety of these products. In Hong Kong, safety information on herbal medicines has come from the enquiries and reports received by our Drug and Poisons Information Service, on-going surveillance of patients treated in a large general teaching hospital and review of reports from the medical literature. Circumstances under which poisonings have occurred are also analysed in order to devise preventive measures. Once collected, this information is then distributed to health professionals in Hong Kong and abroad. WHO projects and pilot studies in Europe are also under way to promote and facilitate reporting of adverse reactions to herbal medicines.

Chandler F, Osborne F. Burdock. Can Pharm J 1997 Jun;130:46-9.
IPA COPYRIGHT: ASHP The botanical features, traditional and modern medicinal uses, constituents, pharmacology, toxicity, contraindications, precautions, and dosage of burdock (Arctium lappa; Arctium minus) are discussed.

Chavez ML, Chavez PI. Saint John's Wort. Hosp Pharm 1997 Dec;32:1621-8, 1631-2.
IPA COPYRIGHT: ASHP An overview of the chemistry, history, use, pharmacokinetics, and clinical pharmacology of St. John's Wort, a shrubby, perennial weed that has been used as an antidepressant, is presented, including a summary of clinical trials of St. John's Wort for depression as well as for antiviral effects, dosage and administration, and side effects and contraindications.

Chen DF, Zhang SX, Wang HK, Zhang SY, Sun QZ, Cosentino LM, Lee KH. Novel anti-HIV lancilactone C and related triterpenes from Kadsura lancilimba. J Nat Prod 1999;62(1):94-7.
Three new triterpene lactones, lancilactones A (1), B (2), and C (3), together with the known kadsulactone A (4), were isolated from the stems and roots of Kadsura lancilimba. Their structures and stereochemistries were determined primarily from mass and NMR spectral data. Compound 3 inhibited HIV replication with an EC50 value of 1.4 microg/mL and a therapeutic index of greater than 71.4.

Chung KT, Wong TY, Wei CI, Huang YW, Lin Y. Tannins and human health: a review. Crit Rev Food Sci Nutr 1998;38(6):421-64.
Tannins (commonly referred to as tannic acid) are water-soluble polyphenols that are present in many plant foods. They have been reported to be responsible for decreases in feed intake, growth rate, feed efficiency, net metabolizable energy, and protein digestibility in experimental animals. Therefore, foods rich in tannins are considered to be of low nutritional value. However, recent findings indicate that the major effect of tannins was not due to their inhibition on food consumption or digestion but rather the decreased efficiency in converting the absorbed nutrients to new body substances. Incidences of certain cancers, such as esophageal cancer, have been reported to be related to consumption of tannins-rich foods such as betel nuts and herbal teas, suggesting that tannins might be carcinogenic. However, other reports indicated that the carcinogenic activity of tannins might be related to components associated with tannins rather than tannins themselves. Interestingly, many reports indicated negative association between tea consumption and incidences of cancers. Tea polyphenols and many tannin components were suggested to be anticarcinogenic. Many tannin molecules have also been shown to reduce the mutagenic activity of a number of mutagens. Many carcinogens and/or mutagens produce oxygen-free radicals for interaction with cellular macromolecules. The anticarcinogenic and antimutagenic potentials of tannins may be related to their antioxidative property, which is important in protecting cellular oxidative damage, including lipid peroxidation. The generation of superoxide radicals was reported to be inhibited by tannins and related compounds. The antimicrobial activities of tannins are well documented. The growth of many fungi, yeasts, bacteria, and viruses was inhibited by tannins. We have also found that tannic acid and propyl gallate, but not gallic acid, were inhibitory to foodborne bacteria, aquatic bacteria, and off-flavor-producing microorganisms. Their antimicrobial properties seemed to be associated with the hydrolysis of ester linkage between gallic acid and polyols hydrolyzed after ripening of many edible fruits. Tannins in these fruits thus serve as a natural defense mechanism against microbial infections. The antimicrobial property of tannic acid can also be used in food processing to increase the shelf-life of certain foods, such as catfish fillets. Tannins have also been reported to exert other physiological effects, such as to accelerate blood clotting, reduce blood pressure, decrease the serum lipid level, produce liver necrosis, and modulate immunoresponses. The dosage and kind of tannins are critical to these effects. The aim of this review is to summarize and analyze the vast and sometimes conflicting literature on tannins and to provide as accurately as possible the needed information for assessment of the overall effects of tannins on human health.

Chyau CC, Mau JL. Release of volatile compounds from microwave heating of garlic juice with 2,4-decadienals. Food Chem 1999;64(4):531-5.
BIOSIS COPYRIGHT: BIOL ABS. Garlic (Allium sativum L.) juice and 2,4-decadienals were heated in a microwave oven at the full power of 700 W. The volatile compounds of heated samples were isolated using diethyl ether solvent extraction and analysed using gas chromatography and gas chromatography-mass spectrometry. A total of 23 compounds were identified from these samples, among which 14 sulfide compounds, five aldehydes, two alcohols, one acid and one furan were identified. Three tentatively identified compounds, dithio(1-propenyl)propionate, dihydro-2(3H)-thiophenthione and n-hexanethiol were newly found in deep-fried garlic flavor. During microwave heating, levels of most volatiles decreased as the heating time continued. 2-Pentylfuran, isopropyl alcohol, hexanal and (E)-2-octenal were formed from the degradation of 2,4-decadienals. Sulfur dioxide was generated predominantly from the degradation and oxidation of sulfide compounds.

Cicero LA, Pareddy SR, Rosenberg JM. Can depression patients be treated with worts? Drug Top 1997 Sep 1;141:24.
IPA COPYRIGHT: ASHP The use of Hypericum perforatum (St. John's Wort) for depression therapy, including results of studies, possible mechanisms of action, toxicity, and dosage, is presented.

Combest WL. Ginger. US Pharm 1998 Feb;23:74, 79, 83-4, 86.
IPA COPYRIGHT: ASHP An overview of the medicinal uses of Zingiber officinale (ginger) is presented, including a discussion of the chemical composition and active constituents of ginger, pharmacology, side effects, and toxicity.

Combest WL. Valerian. US Pharm 1997 Dec;22:62, 64, 66, 68.
IPA COPYRIGHT: ASHP The uses, chemical composition, active constituents, results of clinical studies, toxicity, dosage forms and recommendations of Valerian for insomnia are discussed.

Combest WL, Nemecz G. Echinacea. US Pharm 1997 Oct;22:126, 129-30, 132.
IPA COPYRIGHT: ASHP An overview of the medicinal uses of Echinacea species, which is also called purple coneflower, is presented, and components of active fractions of the plant, various types of Echinacea preparations, and the toxicity of Echinacea are considered.

Cornell S. Alternatives to hormone replacement therapy. Do they measure up to estrogen? Adv Nurse Pract 1997;5(7):45-6, 49, 72.

Crone CC, Wise TN. Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy. Psychosomatics 1998;39(1):3-13. Consultation-liaison psychiatrists evaluate a wide variety of patients who are often disillusioned with conventional medical care and are seeking to gain some measure of control over their illness. With the growing popularity of alternative health care practices, consultation-liaison psychiatrists must learn more about the implications of herbal medicine usage. This review provides an overview of herbal medicines, a vital component of the alternative medicine movement.

Dasgupta P, Fowler CJ. Chillies: from antiquity to urology. Br J Urol 1997;80(6):845-52.

Davis WM. Most frequently asked questions regarding depression. Drug Top 1997 Oct 6;141:98-107.
IPA COPYRIGHT: ASHP Types of depression, risk factors, symptoms, causes, suicidal risk, genetic role, and therapy of clinical depression with antidepressants, including their side effects, effects on sex life, types of drugs used during pregnancy, herbal drugs, ethyl alcohol interactions, and electroconvulsive therapy, are discussed. This article qualifies for 2 hours U.S. CE credit by the ACPE.

De Smet PA. The role of plant-derived drugs and herbal medicines in healthcare. Drugs 1997;54(6):801-40.
Many of our present medicines are derived directly or indirectly from higher plants. While several classic plant drugs have lost much ground to synthetic competitors, others have gained a new investigational or therapeutical status in recent years. In addition, a number of novel plant-derived substances have entered into Western drug markets. Clinical plant-based research has made particularly rewarding progress in the important fields of anticancer (e.g. taxoids and camptothecins) and antimalarial (e.g. artemisinin compounds) therapies. In addition to purified plant-derived drugs, there is an enormous market for crude herbal medicines. Natural product research can often be guided by ethnopharmacological knowledge, and it can make substantial contributions to drug innovation by providing novel chemical structures and/or mechanisms of action. In the end, however, both plant-derived drugs and crude herbal medicines have to take the same pharmacoeconomic hurdle that has become important for new synthetic pharmaceuticals.

De Smet PA, Brouwers JR. Pharmacokinetic evaluation of herbal remedies. Basic introduction, applicability, current status and regulatory needs. Clin Pharmacokinet 1997;32(6):427-36.

De Vincenzi M, Mancini E. Monographs on botanical flavouring substances used in foods. Part VI. Fitoterapia 19997;68(1):49-61.
BIOSIS COPYRIGHT: BIOL ABS. RRM LITERATURE REVIEW ORIGANUM-MAJORANA ORIGANUM-CRETICUM MELITTIS-MELISSOPHYLLUM STACHYS-OFFICINALIS AJUGA-CHAMAEPITYS GALEOPSIS-SEGETUM POGOSTEMON-CABLIN VERBASCUM-DENSIFLORUM VERONICA-ALLIONII VERONICA-OFFICINALIS BALLOTA-NIGRA SALVIA-OFFICINALIS SATUREJA-MONTANA MARJORAM WOOD BETONY AJUGA PATCHOULI MULLEIN SPEEDWELL BLACK HOREHOUND SAGE WINTER SAVORY BIOCHEMISTRY AND BIOPHYSICS FOODS BOTANICAL FLAVORING SUBSTANCES CHEMICAL COMPONENTS TOXIC PROPERTIES.

Debrunner B, Meier B. Petasites hybridus: a tool for interdisciplinary research in phytotherapy. Pharm Acta Helv 1998;72(6):359-62.
The 3rd Petasites gathering took place in Romanshorn, Switzerland on March 29, 1996 and gave 16 European scientists the opportunity to transmit their latest considerable discoveries to interested researchers working in different scientific disciplines such as pharmacognosy, botany, chemistry, pharmacology, medicine or clinical pharmacy. The newest findings on Petasites hybridus as a significant plant drug showed very promising aspects of therapeutic utility. Great progress has been made in chemical analytical methods and the determination of pharmacological activities. Substantial advances have also occurred in the production of bioassay procedures and plant materials, particularly utilizing cell- and tissue-culture techniques.

Donaldson K. Introduction to the healing herbs. ORL Head Neck Nurs 1998;16(3):9-16.
For centuries, man has used plants for their healing properties. Today we refer to these plants as herbs. These plants play a principal part in all treatment modalities, both ancient and modern. The gentle, nourishing, and synergistic actions of herbal medicine make it an excellent treatment choice for all systems. Properties of ten commonly used herbs will be discussed. The herbs will be reviewed for their history, actions, indications and safety.

Duke CC, Moore DE, Roufogalis BD. St. John's wort. N Z Pharm 1998 Jan;18:13-4.
IPA COPYRIGHT: ASHP The characteristics, biological activity, common uses, clinical trials, and adverse effects of Hypericum perforatum (St. John's wort) are discussed.

Duncan MG. The effects of nutritional supplements on the treatment of depression, diabetes, and hypercholesterolemia in the renal patient. J Ren Nutr 1999;9(2):58-62.
The independent use of nutritional supplements has increased dramatically over the past several years. St. John's Wort for the treatment of depression, chromium for improvement of abnormal glucose and insulin regulation, and garlic for hypercholesterolemia, are among the more popular nutritional supplements being used by the population at large for their respective conditions. Depression, diabetes, and hypercholesterolemia are common to the renal patient. However, the efficacy of St. John's Wort, chromium, and garlic for these problems in the patient with impaired renal function is not known. This article reviews the pharmacology, efficacy, safety, and pharmokinetics of these three food supplements in the nonrenal patient. There are encouraging data suggesting successful treatment in the otherwise normal individual. However, clinical studies examining the safety of these three supplements for the treatment of depression, diabetes, and hypercholesterolemia in the patient with renal disease are lacking and preclude recommendation of their use.

Dunford A, Eldin S. Useful plants [letter; comment]. J R Soc Med 1997;90(3):178-9.

Eliason BC. Alternative medicine--the case of herbal remedies [letter]. N Engl J Med 1999;340(7):564; Discussion 566.

Eliason BC, Kruger J, Mark D, Rasmann DN. Dietary supplement users: demographics, product use, and medical system interaction. J Am Board Fam Pract 1997;10(4):265-71.
BACKGROUND: Dietary supplements-defined as vitamins and minerals, herbal products, tissue extracts, proteins and amino acids, and other products-are purchased to improve health and prevent disease. Little has been published, however, about the characteristics of either the products or the people who use them. METHODS: Consecutive customers visiting two health food stores during a 15-day period were interviewed by telephone. They were asked about their use of dietary supplements, demographics, and their use of the established health care system. RESULTS: Of the 194 customers contacted, 136 (70.1 percent) completed the survey. Respondents took a total of 805 supplements, most often to prevent a health problem (84.3 percent). Herbal products were most commonly used. Garlic, ginseng, and Ginkgo biloba were the herbs most frequently used. Fifty products were found to have previously reported toxicities, including vitamin A, which 9 customers were taking in megadoses. Most customers were white (94.1 percent), female (75.7 percent), had at least 1 year of college education (70.6 percent), had health insurance (95.6 percent), and had a regular physician (85.3 percent). CONCLUSION: Most of the dietary supplements consumed appear to be safe, but 50 of 805 had previously reported toxicities including megadoses of vitamin A. Garlic, ginseng, and Ginkgo biloba were the most commonly ingested herbs, and the medical literature supports their effectiveness for some conditions in humans. Customers of two health food stores had average to above-average education and took dietary supplements to stay healthy. They used the conventional health care system but did not typically consult their physician about dietary supplements. The pattern of use suggests that physicians might not be adequately addressing preventive and wellness issues in discussions with their patients. Furthermore, physicians might need to learn about dietary supplements so they can communicate with patients about them.

Etkin NL. Indigenous patterns of conserving biodiversity: pharmacologic implications. J Ethnopharmacol 1998;63(3):233-45.
The accelerating rate at which the world's botanical resources are being depleted today has inspired redoubled efforts on the part of global conservation programs. For the most part, this reflects the actions of outsiders who are culturally and politically detached from the threatened environments, and who identify species for conservation through western economic models. In view of this, ethnopharmacologists--and primarily those representing the social sciences--have drawn attention to the cogency of indigenous knowledge of biotic diversity and its conservation. This paper reviews how local paradigms of plant management promote conservation, and problematizes the issue specifically to the use of plants by Hausa peoples in northern Nigeria. The pharmacologic implications of indigenous patterns of plant use and conservation derive from the manifold and overlapping contexts in which plants, especially wild species, are used by local communities. These applications identify the importance of particular species and should be employed in assigning priority for the conservation of plants.

Falch B, Reichling J, Saller R. [Ginger: not only a spice. Investigation of effects and effectivity]. Dtsch Apoth Ztg 1997 Nov 20;137:47-52, 55-60.(Ger)
IPA COPYRIGHT: ASHP The occurrence, morphological, microscopical, and organoleptic characteristics, constituents, traditional and modern uses, pharmacological effects, clinical and toxicological investigations, dosages, and methods of the application of ginger (Zingiber officinale Roscoe) rhizome and its medical preparations are discussed.

Fisher E, Lacy E. Nutrition: nonvitamin food supplements. Pharm Times 1997 Nov;63:97-105.
IPA COPYRIGHT: ASHP An overview of nonvitamin food supplements is presented, including bee pollen, bioflavonoids, carnitine, chromium, ubidecarenone (coenzyme Q-10), ginseng, kelp, melatonin, and tryptophan; the problems associated with the studies performed on nonvitamin food supplements, the sources of claims made for them, potential problems with self-administration of nonvitamin food supplements by the patient, the possible adverse effects of such supplements, and the process of counseling patients on the relative merits of supplementing one's diet with these substances are also discussed. This article qualifies for 2 hours U.S. CE credit by the ACPE.

Gaedcke F. [St. John's Wort and its preparations: evaluation of quality with the aid of a selective reproducible HPLC procedure]. Dtsch Apoth Ztg 1997 Oct 16;137:117-21. (Ger)
IPA COPYRIGHT: ASHP The assessment of the pharmaceutical quality of the active principles of St. John's Wort (Hypericum perforatum), including hypericin and pseudohypericin, using a specially developed method with HPLC is discussed.

Germer S, Franz G. [Ginger: manifold medicinal crude drug. Uses and thin layer chromatographic (TLC) assay according to the German Pharmacopeia 1997]. Dtsch Apoth Ztg 1997 Nov 20;137:40-6. (Ger)
IPA COPYRIGHT: ASHP A discussion of the crude drug ginger (Zingiber officinale Roscoe) is presented, including historical and botanical aspects, cultivation and harvesting, processing the rhizome, potential adulteration, contents of active substances, and uses. Pharmacopeial methods of TLC analysis of the active ingredients in ginger extracts are included.

Gillespie SG. Herbal drugs and phytomedicinal agents. Pharm Times 1997 Dec;63:53-62.
IPA COPYRIGHT: ASHP An overview of herbal drugs and phytomedicinal agents is presented, including a discussion of the history of herbal medicine, an outline of the regulation of herbal drugs in the United States and Europe, the extent and the demographics of use of herbal drugs, the characteristics of herbal drugs regarding composition, standardization, and dosage forms, and the indications, contraindications, dose, and side effects of selected herbal drugs. This article qualifies for 2 hours U.S. CE credit by the ACPE.

Goldman LS. Use of herbal medicines among C-L populations [letter]. Psychosomatics 1998;39(5):482.

Goodyear K, Lewith G, Low JL. Randomized double-blind placebo-controlled trial of homoeopathic 'proving' for Belladonna C30. J R Soc Med 19998;91(11):579-82.
Homoeopathic drug pictures are developed by recording the symptomatic effects of homoeopathic remedies given to healthy volunteers (a 'proving'). In a double-blind randomized controlled trial we tested the hypothesis that individuals using an infinitesimal dilution of Belladonna (thirtieth potency, C30) would record more true symptoms, on a questionnaire that contained both true and false Belladonna proving symptoms, than those receiving placebo. 60 volunteers entered the study and 47 completed data collection. We were unable to distinguish between Belladonna C30 and placebo using our primary outcome measure. For the secondary outcome measure we analysed the number of individuals who proved to the remedy according to our predefined criteria: 4 out of 19 proved in the Belladonna C30 group and 1 out of 27 in the placebo group (difference not statistically significant). This pilot study does not demonstrate a clear proving reaction for Belladonna C30 versus placebo, but indicates how the question might be further investigated.

Gori M, Campbell RK. Natural products and diabetes treatment. Diabetes Educ 1998;24(2):201-2, 205-8.
Many natural products are promoted to improve the health status of patients with diabetes by people making a profit on these products. Few of these claims have any scientific basis. Certain natural products are potentially damaging to patients with chronic diseases, especially if the products are used instead of proven scientific treatment regimens. Many individuals believe that if a product is natural it must be effective and safe. What is ironic is that if the products were safe and effective, and if studies would have been done on humans to prove safety and effectiveness, the sales of the products would greatly increase (as opposed to present limited sales as herbs from health food stores). Some of the products do have a beneficial effect, especially as a placebo if the patient believes that the product is going to work. As can be seen from the summary of products that are listed here that claim to improve the treatment of patients with diabetes, very few are available in a standard form that would produce a known positive effect. The few products that do have a mild impact on lowering blood glucose levels are much less effective than standard treatments. In a recent review of the role of plant-derived drugs and herbal medicines in healthcare, no natural products were listed as having a beneficial effect on diabetes. Diabetes care providers need to confront the issue of the use of natural products with their patients. Patients should be taught the importance of using proven, effective treatment regimens. Any patient who decides to use a natural product should be followed closely to make sure that no toxic effects occur and that treatment objectives are achieved.

Grabarczyk H, Horoszkiewicz M, Bloszyk E. [Plant extracts in cosmetics]. Farm Pol 1997;53(6):250-7. (Pol)

Grauds C. At last--standardized botanical products. Pharm Times 1997 Apr;63:107.
IPA COPYRIGHT: ASHP The development of standardized botanical products is described, including the process of extraction of the plant material, how standards might be defined differently among competitive companies, and establishing therapeutic validity for standardized botanical products.

Grauds C. Herbal ephedra and the pharmacist. Pharm Times 1998 Mar;64:60, 62.
IPA COPYRIGHT: ASHP An overview of the popular herb ephedra (Ephedra species; Ma Huang), an herbal equivalent and precursor to the drugs ephedrine and pseudoephedrine, is presented, including the importance of pharmacists providing consultation to patients using this herb, indications for ephedra use, side effects, contraindications, and U.S. Food and Drug Administration (FDA) warnings and restrictions on ephedra-containing products.

Grauds C. Strong herb sellers: up-and-comers for 1998. Pharm Times 1998 May;64:48, 50.
IPA COPYRIGHT: ASHP The top 10 selling herbs as a result of a growing herbal market are listed, and research on the efficacy of Hypericum perforatum (St. John's wort) for depression and its potential drug interactions are briefly presented.

Gresser G. [Broom: medicinal and poisonous plant, plantation net and devil's broom]. Dtsch Apoth Ztg 1998 Mar 5;138:51-2, 55-9. (Ger)
IPA COPYRIGHT: ASHP An overview of the etymology, botanical characteristics, distribution range, active constituents, including biogenic amines, flavonoids and iso-flavonoids, along with the therapeutic uses and toxicity of the plant broom, Cytisus scoparius (L) LINK (Leguminose), is presented.

Grush LR, Nierenberg A, Keefe B, Cohen LS. St. John's Wort during pregnancy. JAMA 1998 Nov 11;280:1566.
IPA COPYRIGHT: ASHP The cases of 2 women, ages 38 and 43 yr, who took Hypericum perforatum (St. John's Wort) in preference to standard antidepressant therapy during pregnancy are reported; the first patient experienced a recurrence of major depression during her first trimester of pregnancy and initiated H. perforatum at 900 mg/day, and the second patient discontinued fluoxetine hydrochloride and methylphenidate hydrochloride, which had been prescribed for refractory depression, and substituted 900 mg/day of H. perforatum. In the first patient, pregnancy and labor were uneventful, and the infant had Apgar scores of 9 at 1 and 5 min. The patient discontinued H. perforatum and began breastfeeding. The baby developed jaundice on day 5, which required brief phototherapy. The patient resumed H. perforatum on day 20 at 300 mg/day, but continued breastfeeding. Examination of the baby at 4 and 33 days was within the normal range.

Halberstein RA. Traditional botanical remedies on a small Caribbean island: Middle (Grand) Caicos, West Indies. J Altern Complement Med 1997;3(3):227-39.
A descriptive survey of 18 medicinal plants utilized on Middle (Grand) Caicos Island in the West Indies revealed that each species has multiple applications. Phytochemical constituents, ascertained from published sources, suggest pharmacological/physiological efficacy in the ethnomedical treatment of various disorders. Traditional preparation procedures may enhance the chemotherapeutic value of the plant derivatives, while at the same time reducing their potential toxicity. The majority of species used in Middle Caicos are also exploited in other cultures but often for very different purposes.

Hammond GB, Fernandez ID, Villegas LF, Vaisberg AJ. A survey of traditional medicinal plants from the Callejon de Huaylas, Department of Ancash, Peru. J Ethnopharmacol 1998;61(1):17-30.
The medicinal uses of local flora from the Callejon de Huaylas, Department of Ancash, northeastern Peru, are reported. This geographical area has an old tradition of herbal healing. A total of 33 species have been documented through interactions with village elders, traditional doctors and herbalists. Of the 33 medicinal plant species surveyed in the Callejon de Huaylas, six have not been previously reported, seven have received only minor phytochemical coverage in the literature, and the medicinal uses of seven other plants have not been corroborated with traditional medicinal reports from around the world. The traditional medicinal uses of six medicinal plants have been corroborated with previously published reports but their biological activities have yet to be confirmed in the laboratory. The medicinal uses of four other plants have been corroborated with previously published reports and their biological activities have been confirmed in the laboratory. The purported medicinal use of three plant species could not be confirmed in the laboratory.

Harrison P. Herbal medicine takes root in Germany [see comments]. CMAJ 1998;158(5):637-9.
The sale of Herbal Medicine is a growth industry in Germany, where physicians routinely prescribe these products and annual sales have surpassed $ 2 billion. Pam Harrison says the rising popularity has been driven by German patients, who began demanding herbal alternatives to synthetic drugs. Medical schools responded by reintroducing lessons on a topic that had been phased out of the medical curriculum.

Havlick HD. From the customer's perspective. Natural Pharm 1998 Aug;2:1, 10-1.
IPA COPYRIGHT: ASHP The importance of pharmacists in keeping abreast of natural and herbal products in light of the fact that more consumers purchase their natural products from pharmacies rather than health food stores is discussed, including what consumers look for when purchasing an herbal product, and how pharmacists might better serve their customers and increase their customer base.

Heiligenstein E, Guenther G. Over-the-counter psychotropics: a review of melatonin, St John's wort, valerian, and kava-kava. J Am Coll Health 1998;46(6):271-6.
Use and availability of alternative healthcare products have revived in the last few years. The prevalence of supplement use in the United States is largely unknown but is thought to be widespread. In this article, four of the common substances used to treat emotional problems are reviewed. The plant or substance description, clinical indications, evidence of therapeutic efficacy, mechanisms of therapeutic actions, dosages and regimens, different commercially available preparations, and adverse effects and toxicities are described for melatonin, St John's wort, valerian, and kava-kava. That a product is "natural" does not mean that it is either safe or effective. Many supplements are potent drugs that lack sufficient data on safety, dose-response relationships, drug interactions, and purity.

Heinrich M, Ankli A, Frei B, Weimann C, Sticher O. Medicinal plants in Mexico: healers' consensus and cultural importance. Soc Sci Med 1998;47(11):1859-71.
Medicinal plants are an important element of indigenous medical systems in Mexico. These resources are usually regarded as part of a culture's traditional knowledge. This study examines the use of medicinal plants in four indigenous groups of Mexican Indians, Maya, Nahua, Zapotec and - for comparative purposes - Mixe. With the first three the methodology was similar, making a direct comparison of the results possible. In these studies, the relative importance of a medicinal plant within a culture is documented using a quantitative method. For the analysis the uses were grouped into 9-10 categories of indigenous uses. This report compares these data and uses the concept of informant consensus originally developed by Trotter and Logan for analysis. This indicates how homogenous the ethnobotanical information is. Generally the factor is high for gastrointestinal illnesses and for culture bound syndromes. While the species used by the 3 indigenous groups vary, the data indicate that there exist well-defined criteria specific for each culture which lead to the selection of a plant as a medicine. A large number of species are used for gastrointestinal illnesses by two or more of the indigenous groups. At least in this case, the multiple transfer of species and their uses within Mexico seems to be an important reason for the widespread use of a species. Medicinal plants in other categories (e.g. skin diseases) are usually known only in one culture and seem to be part of its traditional knowledge.

Heinrich M, Robles M, West JE, Ortiz De Montellano BR, Rodriguez E. Ethnopharmacology of Mexican asteraceae (Compositae). Annu Rev Pharmacol Toxicol 1998;38:539-65.
Traditional herbal remedies have increased in popularity in Europe and the United States in recent years but have always been important to people living in rural Mexico and to their Mexican American/Chicano descendants in the United States. Mexican American patients will often be ingesting herbal teas at the same time that they are being treated for their ailments with antibiotics or antiinflammatory agents. The plant family Asteraceae (Compositae) has contributed the largest number of plants to this pharmacopoeia; the reasons for the importance of this family include its large number of species in Mexico and its wide array of natural products that are useful in the treatment of the maladies that have afflicted the inhabitants of rural Mexico. These natural products include sesquiterpene lactones, polyacetylenes, alkaloids, monoterpenes, and various phenolics such as flavonoids. In this review, we emphasize the sesquiterpene lactones, a large group of compounds with antiinflammatory properties and the ability to relax smooth muscles and thereby relieve gastrointestinal distress. These compounds also readily form adducts with glutathione or free thiols and can thereby affect the metabolism, activity, and toxicology of a wide array of pharmacological agents.

Hendriks H. Pharmaceutical aspects of some Mentha herbs and their essential oils. Perfum Flavor 1998 Nov-Dec;23:15-23.
IPA COPYRIGHT: ASHP An overview of some herbs and essential oils of the Mentha species that are used in pharmaceuticals, including M. piperita (peppermint), peppermint oil, M. arvensis (cornmint; Japanese mint), cornmint oil, M. pulegium (pennyroyal), pennyroyal oil, M. spicata (spearmint), M. cardiaca (spearmint), and spearmint oil, is presented, including their quality control, formulations, therapeutic uses, adverse effects, and toxicity; menthol, a constituent of Mentha species essential oils, is mentioned.

Hippius H. St John's Wort (Hypericum perforatum)--a herbal antidepressant. Curr Med Res Opin 1998;14(3):171-84.
A number of clinical studies conducted over the past few years have indicated that whole extract of St John's wort (Hypericum perforatum L.) has antidepressant effects. The herbal antidepressant St John's wort offers promising results in the treatment of patients with mild and moderate depression (response rate of 60-70% estimated by analysis of pooled data). St John's wort preparations are well tolerated. Their use rarely leads to adverse drug reactions which, when they do occur, are mainly subjective symptoms (e.g. gastrointestinal, dizziness). The generally good tolerability of St John's wort preparations and the resulting high patient compliance in taking the prescribed medication, in conjunction with their efficacy in mild and moderate depression, make these preparations particularly suitable for use in outpatient practice. Tolerability is also very good in elderly patients. If a sufficiently high-dose course of treatment with St John's wort preparations (900 mg daily) does not lead to a clear improvement in depression after four to six weeks, therapy should be continued with an established ('classical') antidepressant.

Hu SY. Herbal teas and populace health care in tropical China. Am J Chin Med 1997;25(1):103-34.
Commercial Chinese herbal tea is the development of the populace in tropical and subtropical China consequential to their fight against infectious diseases and their struggle to explore local plants to relieve fever, to alleviate pain, to restore strength and to modulate immunity against viral epidemics. From these ethnomedical experiences, two types of herbal teas were commercialized, namely, liangcha and medicated teas. Liangcha refers to a ready-made decoction infused from wild plants served in simple stores in cities and towns. Medicated teas are parcelled material prepared from crude drugs with or without tea (Camellia sinensis [L.] O. Ktze,), sold in colorful boxes and bags to people for use at home. Investigations of liangcha were made in Hong Kong and Macao, and studies for medicated teas were done from samples obtained in Chinese stores at Boston. A total of 127 source species of these herbal teas were identified and arranged in two alphabetical lists by the botanical names, each followed by an English common name in parenthesis, part used, frequency in samples, and family. External recognizing characters of medicated teas, discussions of problems encountered in identifying source species, relevant toxicities, and potential new vegetal pharmaceutical resources are given.

Huxtable RJ. Safety of botanicals: historical perspective [editorial]. Proc West Pharmacol Soc 1998;41:1-10.

Iorio L, Nacca RG, Simonelli R. Cistercian medicinal herbs for renal therapy in the 15th century. Am J Nephrol 1997;17(3-4):286-8.
The rule conceived the monastery as a citadel of divine service so that medicine, together with other arts, was the subject of studies and searches which contributed to the foundation of monastic medicine. In the 14th and 15th centuries, Cistercian monks did not limit themselves to the study of the ancient treatises on medicinal herbs, but enlarged their knowledge through clinical experience to such an extent that they created the principal therapy of diseases for about five centuries.

Jambor J. [Strategies for the development of herbal drugs market]. Farm Pol 19998;54(5):201-9. (Pol)

Johnson ST, Wordell CJ. Homeopathic and herbal medicine: considerations for formulary evaluation. Formulary 1997 Nov;32:1166-8, 1171-3.
IPA COPYRIGHT: ASHP The principles, efficacy, risks, regulation, and examples of homeopathy and herbal medicine therapy, and formulary considerations for these types of alternative medicine are discussed.

Keplinger K, Laus G, Wurm M, Dierich MP, Teppner H. Uncaria tomentosa (Willd.) DC.--ethnomedicinal use and new pharmacological, toxicological and botanical results. J Ethnopharmacol 1999;64(1):23-34.
The medicinal system of the Ashaninka Indians in Peru is portrayed. Three categories of medical disorders and healers are recognized. A human is viewed to consist of a physical and a spiritual being who communicate with each other by means of a regulating element. The significance of Uncaria tomentosa (Willd.) DC. (Rubiaceae), locally known as una de gato, in traditional medicine is emphasized by its exclusive use by priests to influence this regulation. Pharmacological and toxicological results obtained with extracts or isolated compounds are summarized. Pentacyclic oxindole alkaloids stimulate endothelial cells in vitro to produce a lymphocyte-proliferation-regulating factor. Tetracyclic oxindole alkaloids act as antagonists. A significant normalization of lymphocyte percentage was observed in vivo although total leucocyte numbers did not change.

Khaliq Y. Alternative medicine: what pharmacists need to know. Pharm Pract 1997 Mar;13:44-50, 83-5.
IPA COPYRIGHT: ASHP An overview of alternative medicine with a focus on herbal medicine, homeopathy, and vitamin therapy is presented; the attitudes of patients, physicians, and pharmacists, benefits of alternative medicine, disadvantages of these therapies, such as lack of evidence, toxicity, drug interactions, and lack of regulation and quality control, and the pharmacist's role are discussed.

Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999;56(2):125-38; Quiz 139-41.
Unsafe and potentially safe herbal therapies are discussed. The use of herbal therapies is on the rise in the United States, but most pharmacists are not adequately prepared educationally to meet patients' requests for information on herbal products. Pharmacists must also cope with an environment in which there is relatively little regulation of herbal therapies by FDA. Many herbs have been identified as unsafe, including borage, calamus, coltsfoot, comfrey, life root, sassafras, chaparral, germander, licorice, and ma huang. Potentially safe herbs include feverfew, garlic, ginkgo, Asian ginseng, saw palmetto, St. John's wort, and valerian. Clinical trials have been used to evaluate feverfew for migraine prevention and rheumatoid arthritis; garlic for hypertension, hyperlipidemia, and infections; ginkgo for circulatory disturbances and dementia; ginseng for fatigue and cancer prevention; and saw palmetto for benign prostatic hyperplasia. Also studied in formal trials have been St. John's wort for depression and valerian for insomnia. The clinical trial results are suggestive of efficacy of some herbal therapies for some conditions. German Commission E, a regulatory body that evaluates the safety and efficacy of herbs on the basis of clinical trials, cases, and other scientific literature, has established indications and dosage recommendations for many herbal therapies. Pharmacists have a responsibility to educate themselves about herbal therapies in order to help patients discern the facts from the fiction, avoid harm, and gain what benefits may be available.

Kligler B. Herbal medicines and the family physician [editorial; comment]. Am Fam Physician 1998;58(5):1064-5.

Klink B. Alternative medicines: is natural really better? Drug Top 1997 Jun 2;141:99, 103.
IPA COPYRIGHT: ASHP The rapid sales growth and risks vs benefits of alternative medicine and herbal products and the role of the pharmacists who sell these products are discussed.

Kosalec I. [History and future of Echinacea species--natural immunostimulating plants]. Farm Glas 1998 May;54:161-70. (Scr)

Kozyrskyj A. Herbal products in Canada. How safe are they? [see comments]. Can Fam Physician 1997;43:697-702.
OBJECTIVE: To examine existing evidence and inform family physicians about issues concerning herbal product use in Canada. QUALITY OF EVIDENCE: The Canadian Food and Drug Act and findings of an Expert Advisory Committee on Herbs and Botanical Preparations were consulted to provide an overview of the issues regarding herbal product regulation in Canada. Case reports of herbal toxicity were identified to illustrate some of the hazards of herbal products, and references provided to guide health professional in searching the literature for clinical trials that evaluate these drugs' efficacy. MAIN FINDINGS: Herbal products not registered as drugs in Canada are sold as foods and are exempt from the drug review process that evaluates product efficacy and safety. This places the public at risk of unwanted effects from the use of herbal products that are adulterated with other substances and of forgoing effective conventional therapy. Moreover, consumers are exposed to a plethora of information portraying herbal products as harmless. Some progress has been made to address these concerns by facilitating the registration of herbal products as drugs. CONCLUSIONS: Most herbal products that were evaluated were unsafe or ineffective, or no information was available to evaluate their efficacy. Despite the perception that herbal products are innocuous, family physicians need to be aware that herbal therapy can be harmful in order to help their patients make informed choices.

Krishnaswamy K, Raghuramulu N. Bioactive phytochemicals with emphasis on dietary practices. Indian J Med Res 1998;108:167-81.
Diet can modify the pathophysiological processes of various metabolic disorders and can be an effective preventive strategy for various disease processes most of which are known to involve oxidative damage. Both nutrient and non-nutrient components of the diet have been recognized for their anti-oxidant and other potential benefits. Plant foods contain phytochemicals such as flavonoids, phenolic acids, etc., which show biological activity. Some common foods used in Indian culinary practices were assessed for their anti-oxidant, anti-mutagenic and anti-carcinogenic effects and vitamin D activity and evaluated for their plausible biological effects. Green leafy vegetables had the highest anti-oxidant activity followed by wheat and rice. Cooking decreased this activity. Eugenol, the active principle of clove, was shown to offer protection against CCl4 induced hepatotoxicity in rats. It also showed anti-peroxidative activity in addition to decrease in O2 formation. Studies on the anti-carcinogenic effect of turmeric/curcumin revealed that both are potent anti-mutagens in vivo and reduce the adducted DNA levels in liver of rates challenged with B(a)P. In another study, Syrian hamsters receiving turmeric/curcumin through diet or local paint on cheek pouch had lower tumour burden as well as adducted DNA level against 7-12-DMBA challenge. Turmeric/curcumin were found to be better anti-tumour agents when given in the post initiation phase of carcinogenesis. The beneficial effect of turmeric was found to be due to its anti-oxidant potential. Studies on humans at risk of palatal cancer due to reverse smoking showed that turmeric (1 g/day) for 9 months had a significant impact on the regression of precancerous lesions. Onion and garlic also possess anti-mutagenic principle. Further studies on the bioactive phytochemicals in plants showed that certain plants belonging to Solanaceae (Cestrum diurnum, Lycopersicon esculentum and Solanum melongena) have calcinogenic potential and vitamin D like activity. In view of the vast data on bioactive principles from plants, it is suggested that dietary prevention coupled with other life-style changes in perhaps the right answer for prevention of cancer and other chronic diseases in India.

Kumar M, Berwal JS. Sensitivity of food pathogens to garlic (Allium sativum). J Appl Microbiol 1998;84(2):213-5.
The inhibitory activity of garlic (Allium sativum) against Staphylococcus aureus, Salmonella typhi, Escherichia coli and Listeria monocytogenes was measured by the 'turbidity' method. Minimum inhibitory concentration (MIC) of garlic at 80% inhibition level was calculated for these bacteria. All bacterial pathogenic strains tested were inhibited by garlic; E. coli was most sensitive and Listeria monocytogenes was least sensitive. Therefore, garlic has potential for the preservation of processed foods.

La Valle JB. St. John's Wort: there's no magic bullet. Drug Store News Chain Pharm 1998 Jan;8:15.
IPA COPYRIGHT: ASHP The problems associated with the consumer rush to take St. John's Wort (Hypericum perforatum) for depression are discussed, including problems with self-diagnosis and treatment of depression, subtherapeutic dosing of the compound, drug interactions with monoamine oxidase (MAO) inhibitors or other antidepressants, side effects, and methods for discontinuation of traditional antidepressants.

Lavalle J. Ginseng: ancient Chinese cure-all. Drug Store News For Pharm 1997 Feb;7:42.
IPA COPYRIGHT: ASHP The pharmacology, action, indications, toxicities, contraindications, and dosage of ginseng are presented.

Lazarowych NJ, Pekos P. Use of fingerprinting and marker compounds for identification and standardization of botanical drugs: strategies for applying pharmaceutical HPLC analysis to herbal products. Drug Inf J 1998;32(2):497-512.
IPA COPYRIGHT: ASHP The use of HPLC fingerprinting and markers to identify herbal drug materials, set specifications for raw materials, and standardize botanical preparations during manufacturing is discussed; the method was illustrated using Valeriana officinalis (valerian) and Tanacetum parthenium (feverfew).

Lee OS, Kang HH, Han SH. Oriental herbs in cosmetics. Cosmet Toiletries 1997 Jan;112:57-64.
IPA COPYRIGHT: ASHP The use of plant extracts as cosmetic ingredients is presented, including ginseng from Panax ginseng and Swertia for anti-aging preparations, Angelica, Glycyrrhiza (licorice), Lithospermum, and Scutellaria roots as anti-inflammatory agents, Houttuynia, Phellodendron, and Sophora as antimicrobials, Lonicera and Sanguisorba as astringents, Angelica dahurica, Angelica korea, Bupleurum, and Cnidium rhizome as anti-tyrosinase actives, teas as free-radical scavengers, Angelica keiskei, Coptis, and Lonicera as ultraviolet protectants, Morus lhou (mulberry) for skin whitening, and other agents for hair growth and care.

Lepik K. Safety of herbal medications in pregnancy. Can Pharm J 1997 Apr;130:29-33.
IPA COPYRIGHT: ASHP A summary of safety information that is relevant to the use of selected herbal medications during pregnancy is presented, including pharmacologic, toxicologic, and reproductive effects of 26 herbal remedies.

Li Y, Wu YL. How Chinese scientists discovered qinghaosu (artemisinin) and developed its derivatives? What are the future perspectives? Med Trop (Mars) 1998;58(3 Suppl):9-12.
Since the middle of this century and especially since the 1960s and 1970s. Chinese scientists have put considerable effort and resources into the search for new antimalarial compounds extracted from Chinese traditional herbs. Archaeological findings indicate that qinghao (Artemisia annua L.) has been used as a traditional remedy in China for over two thousand years. Its antimalarial principle was finally isolated in 1971 and named artemisinin or qinghaosu (meaning the principle of qinghao in Chinese). Its rapid action, low toxicity and powerful effect against falciparum malaria made it a favored subject for research. In 1976, the unique structure of the molecule, characterized by an endoperoxide and an alternative O-C-O-C segment, was identified. The specific lactone reduction discovered during the determination of the structure opened the way for the synthesis of qinghaosu derivatives, and thereafter a series of more active and more oil- or water-soluble derivatives was developed. Subsequent studies of the structure/activity relationship led to the discovery of dihydroartemisinin, artemether and artesunate. Now qinghaosu and these three derivatives are being used around the world as effective new antimalarial drugs in the fight against falciparum malaria, including multi-drug-resistant Plasmodium falciparum. At the present time new qinghaosu analogues or derivatives are being developed and studies of their structure/activity relationships, their antimalarial mechanisms, their interaction with ferrous ions and the DNA damage associated with these processes are being actively pursued. In addition, recent studies also indicate that some qinghaosu derivatives have other bioactivities, including antiparasitic (against Schistosoma japonicum, Toxoplasma gondii and so on) and anticancer activities. Research into qinghaosu and its derivatives has already produced and will no doubt continue to produce results of the utmost importance in the fight against malaria and other diseases.

Locock RA. Herbal medicine: Essiac. Can Pharm J 1997 Feb;130:18-9, 51.
IPA COPYRIGHT: ASHP The actions and uses of the herbal preparation, Essiac, and its constituents, including Arctium lappa L. (burdock root), Rumex acetosella L. (sheep sorrel herb), Ulmus fulva Michaux (slippery elm bark), Rheum palmatum L. (turkey rhubarb root), Nasturtium officinale (Rorippa nasturtium; watercress), Laminariales species (kelp), Cnicus (blessed thistle), and Trifolium pratense L. (red clover), are presented.

Mamedov NA, Craker LE. Herbs and plant systematics. J Herbs Spices Med Plants 1997;5(2):1-2.
IPA COPYRIGHT: ASHP The methodology of plant systematics and the importance of using systematics in the search for new medicinal and aromatic plant materials are discussed.

Manandhar NP. Native phytotherapy among the Raute tribes of Dadeldhura district, Nepal. J Ethnopharmacol 1998;60(3):199-206.
The herbal drugs used by the Raute tribe of far-western Nepal are discussed. A total of 47 species of plants including one species of pteridophyte, four monocotyledons and 42 dicotyledons, and 17 types of diseases treated, have been identified from this study. Medicinal uses of 15 species (31%) are unrecorded from other parts of the country.

Masood E. 'Medicinal plants threatened by over-use' [news] [see comments]. Nature 1997;385(6617):570.

McIntyre RV. Herbal healers [editorial]. J Okla State Med Assoc 1998;91(5):271.

McKinney DE. Saw palmetto for benign prostatic hyperplasia. JAMA 1999 May 12;281:1699.
IPA COPYRIGHT: ASHP A physician's viewpoints regarding the quality of medicinal plant products, particularly extracts of saw palmetto (Serenoa repens) for benign prostatic hypertrophy (BPH) are presented, including 4 major points to consider when evaluating a manufacturer's products for patients. Other plant products that may also have value in the treatment of BPH were briefly discussed.

McLaughlin JL, Rogers LL, Anderson JE. Use of biological assays to evaluate botanicals. Drug Inf J 1998;32(2):513-24.
IPA COPYRIGHT: ASHP The materials and procedures for 4 bioassays used to screen and direct the fractionation of botanical extracts in drug discovery are described, and the application of the methods in the discovery of Annonaceous acetogenins is discussed.

Menke J. Herbal remedies. S D J Med 1997;50(6):207-8.

Milliken W. Malaria and antimalarial plants in Roraima, Brazil. Trop Doct 1997;27(Suppl 1):20-5.
One of the numerous problems created by the gold rush which took place in northern Brazil (Roraima State) at the end of the 1980s was a severe epidemic of malaria amongst the indigenous peoples of the region. Worst hit were the Yanomami Indians, who had lived in almost total isolation prior to this event. The problem has been exacerbated by the development of chloroquine-resistant strains of Plasmodium falciparum. In an effort to identify viable alternatives to dependence on western medicine for malaria treatment, a survey was carried out on the local plant species (wild and cultivated) used for this purpose in Roraima. Fieldwork was carried out amongst seven indigenous peoples, as well as with the non-indigenous settlers. Over 90 species were collected, many of which have been cited as used for treatment of malaria and fevers elsewhere. Knowledge of antimalarial plants was found to vary greatly between the communities, and in some cases there was evidence of recent experimentation. Initial screening of plant extracts has shown a high incidence of significant antimalarial activity amongst the species collected.

Montbriand MJ. Past and present herbs used to treat cancer: medicine, magic, or poison? Oncol Nurs Forum 1999;26(1):49-60.
PURPOSE/OBJECTIVES: To provide an overview of the past and present use of herbs, thereby dispelling the belief that herbs are secret cancer remedies unknown to or ignored by the biomedical community. DATA SOURCES: Historical and current pharmacy, medical, and nursing literature. DATA SYNTHESIS: More than 3,000 species of herbs used in treating cancer since 2838 BC are known to biomedicine, yet popular lay literature persists in perpetrating the myth that medicine has ignored the potential uses of herbs. Secrecy about herbs has been fashionable since the Middle Ages. Magical and virtuous herbs, named in a book of secrets from that age, are examined for their historical and current use in cancer treatment. Popular unproven herbs, as well as proven herbs used in chemotherapy, also are discussed. CONCLUSIONS: Greater accessibility to information about the use of herbs historically, popularly, and currently would help dispel the secrecy, giving healthcare professionals and patients and opportunity to make informed choices. IMPLICATIONS FOR NURSING PRACTICE: Nurses with knowledge of herbs can be valuable resources to patients and professional colleagues. Members of the professional community (nurses, doctors, pharmacists, and social workers) need to take collegial responsibility in informing each other and their patients about herbs, including their potential risks, possible benefits, and antidotes for overdose.

Muller JL, Clauson KA. Top herbal products encountered in drug information requests. Part 2. Drug Ben Trends 1998 Jun;10:21-3.
IPA COPYRIGHT: ASHP An overview of the indications, dosage, side effects, possible drug interactions, and clinical studies of 2 top selling herbal products, Hypericum perforatum (St. John's Wort) and Serenoa repens (saw palmetto), is presented.

Myerscough M. Herbal remedies. How much do you know? Aust Fam Physician 1998;27(11):1037-40.
In this article the importance of knowledge about herbal remedies in general practice is discussed using guarana (Paullinia cupana), St John's wort (Hypericum perforatum), and gingko (Ginkgo biloba) as examples. Obtaining information about herbal remedies can be difficult. Lack of clinical data about the use, safety, efficacy and general practitioner attitudes to herbal remedies creates research opportunities in this area of general practice.

Nemecz G. Chamomile. US Pharm 1998 Mar;23:104, 110, 112, 115-6.
IPA COPYRIGHT: ASHP The therapeutic uses of chamomile, including antiphlogistic, spasmolytic, sedative, hypnotic, analgesic, and antimicrobial effects as well as its chemical composition, pharmacological action, toxicity, and dosage, are presented.

Nemecz G. Saw palmetto. US Pharm 1998 Jan;23:97-8, 100, 102.
IPA COPYRIGHT: ASHP The history, chemical composition, medicinal uses, and adverse effects of Serenoa repens (saw palmetto) are discussed.

Nemecz G, Combest WL. Feverfew. US Pharm 1997 Nov;22:122, 124, 126, 128.
IPA COPYRIGHT: ASHP An overview of the chemical composition and pharmacological effects of feverfew (Tanacetum parthenium), a perennial herb that has shown efficacy in the treatment of migraine headaches, is presented, including a summary of clinical studies of feverfew in the treatment of migraine headaches and arthritis, its anti-inflammatory effects, its effects on platelet aggregation and vascular smooth muscle contraction, its toxicity and adverse effects, and dosage forms and recommended use.

Neuwinger HD, Mebs D. [Boophone disticha: hallucinogenic African plant]. Dtsch Apoth Ztg 1997 Apr 3;137:51-6. (Ger)
IPA COPYRIGHT: ASHP An overview of the botanical characteristics, uses in African folk medicine, chemistry, toxicology, and pharmacology of the hallucinogenic contents of the plant Boophone disticha (L) Herbert (Amaryllidaceae) is presented.

Norton SA. Herbal medicines in Hawaii from tradition to convention. Hawaii Med J 1998;57(1):382-6.
The stories of kava and chaulmoogra demonstrate the importance of herbal products in ancient and recent Hawaiian medicine. Kava is a psychoactive beverage that has been used ceremonially for millennia throughout the Pacific. It is a nonfermented depressant that causes tranquil intoxication in which thoughts and memory remain clear. Its broad pharmacologic activity led to use in Hawaii to treat skin disorders and later in Germany to treat gonorrhea. Kava is now available outside the Pacific basin as a relaxant, emerging as a popular, albeit deritualized, natural product. In the late 19th century, the main treatment for leprosy was chaulmoogra, extracted from Hydnocarpus seeds. Chaulmoogra had been a traditional treatment for skin diseases in Ayurvedic and Chinese medicine. Chaulmoogra from Asian markets was expensive and usually adulterated so the USDA decided to plant Hydnocarpus in Hawaii. Joseph Rock, a botanist at University of Hawaii, trekked through southeast Asia collecting fresh seeds to plant on Oahu. Rock's trees provided chaulmoogra for leprosy patients on Molokai and elsewhere until it was replaced by dapsone. Chaulmoogra, once the treatment for leprosy worldwide, is now nearly forgotten; kava, once poorly known outside the Pacific, is now a widely-used alternative medicine. Hawaii will probably continue its role in the transition of plants from traditional use to conventional use.

Nwosu MO. Aspects of ethnobotanical medicine in southeast Nigeria. J Altern Complement Med 1998;4(3):305-10.
OBJECTIVE: To document the diversity and traditional use of tropical plants as medicine by the indigenous people of southeast Nigeria. DESIGN: Information was obtained by interviews conducted with the aid of questionnaires and facilitators during field surveys carried out from January 1993 to June 1994. Voucher herbarium specimens were identified at the University of Nigeria, Nsukka Herbarium, in collaboration with Bernhard Zepernick (former Curator), Botanisches Museum, Berlin. Specimens were photographed. RESULTS: Data are summarized in the form of a table, summarizing the plants commonly used by the traditional doctors or medicine men. Herbal preparations are arranged alphabetically under family and species. The data are presented in the order: botanical name, collection number, vernacular name, locality, plant habit/status, and reported medicinal applications.

O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used medicinal herbs. Arch Fam Med 1998;7(6):523-36.
A large and increasing number of patients use medicinal herbs or seek the advice of their physician regarding their use. More than one third of Americans use herbs for health purposes, yet patients (and physicians) often lack accurate information about the safety and efficacy of herbal remedies. Burgeoning interest in medicinal herbs has increased scientific scrutiny of their therapeutic potential and safety, thereby providing physicians with data to help patients make wise decisions about their use. This article provides a review of the data on 12 of the most commonly used herbs in the United States. In addition, we provide practical information and guidelines for the judicious use of medicinal herbs.

Palsson K, Jaenson TG. Plant products used as mosquito repellents in Guinea Bissau, West Africa. Acta Trop 1999;72(1):39-52.
By standardized interviews of people in 23 rural villages, in the Oio region of Guinea Bissau, we collected data on which plant species and plant derived products or methods people use to reduce mosquito biting activity.The following plants were used to reduce numbers of mosquitoes indoors at night: fresh or smouldering Hyptis suaveolens Poit. (Lamiaceae), smoke of the bark of Daniellia oliveri Rolfe (Caesalpiniaceae), smoke of the infructescence of Elaeis guineensis Jacq. (Arecaceae), smoke of the seed capsules of Parkia biglobosa (Jacq.) Benth. (Mimosaceae), smoke of the leaves of Azadirachta indica A.Juss. (Meliaceae) and Eucalyptus sp. (Myrtaceae), fresh Ocimum canum Sims (Lamiaceae), and fresh Senna occidentalis (L.) Link (Caesalpiniaceae). In two field experiments we estimated the 'repellent activity' of certain of these plants and compared their efficacies with those of two commercially available mosquito repellents, i.e. 'positive' controls. In the first experiment we tested: smouldering H. suaveolens (85.4% repellency); fresh H. suaveolens (73.2%); burning of the bark of D. oliveri (74.7%); and smoke of the leaves of Eucalyptus (72.2%). In the second experiment we tested: smouldering H. suaveolens (83.6% repellency); fresh H. suaveolens (66.5%); burning of the bark of D. oliveri (77.9%); smoke of the leaves of A. indica (76.0%); smoke of the infructescence of E. guineensis (69.0%); fresh O. canum (63.6%); and fresh S. occidentalis; (29.4%). All the products tested, except S. occidentalis were significantly more effective than the negative control.

Paulsen SM. Use of herbal products and dietary supplements by oncology patients--informed decisions? Highlights Oncol Pract 1998;15(4):94-9, 103-6.
IPA COPYRIGHT: ASHP An overview of various herbal products and dietary supplements used in cancer prevention and treatment is presented, including prasterone (dehydroepiandrosterone), green teas, adaptogens such as Echinacea and cat's claw (Uncaria species), bovine cartilage, Larrea tridentata (chaparral), linseed oil (flaxseed oil), Viscum album (mistletoe), pau d'arco (a tea derived from the bark of trees of the Tecoma genus), and shark cartilage as well information on clinical studies and toxicity of these products.

Pepping J. Kava: Piper methysticum. Am J Health Syst Pharm 1999 May 15;56:957-58, 960.
IPA COPYRIGHT: ASHP A brief overview of the pharmacology, pharmacokinetics, dosage, adverse effects, drug interactions, contraindications, and results of clinical studies of kava, an herb used for its anxiolytic and sedative properties, is presented. Kava is derived from the pulverized roots and rhizomes of several subspecies of a pepper plant Piper methysticum.

Pepping J. St. John's Wort: Hypericum perforatum. Am J Health Syst Pharm 1999 Feb 15;56:329-30.
IPA COPYRIGHT: ASHP A brief overview of the pharmacology, dosage, adverse effects, drug interactions, contraindications, and results of clinical studies of Hypericum perforatum (St. John's Wort), an herb used to treat depression, anxiety, and sleep disorders, is presented.

Phillipson D. Pharmacognostical peregrinations. Pharm J 1997 Feb 1;258:176-7.
IPA COPYRIGHT: ASHP An account of one London University pharmacognosy professor's experiences with pharmacists in Australia and Malaysia, where he visited in the autumn of 1996, is presented with a focus on their interest in herbal medicine.

Pittenger J. Herbal treatments find their way into mainstream America. Wis Med J 1997;96(3):30-1.

Posner H. Alternative medicine--the case of herbal remedies [letter]. N Engl J Med 1999;340(7):565; Discussion 566.

Prince CE. Goldenrod (Solidago gigantea, Solidago virgaurea). Nebr Mortar Pestle 1997 Sep;60:8-9.
IPA COPYRIGHT: ASHP The anti-inflammatory properties, toxicity, and results of animal studies of Solidago gigantea and Solidago virgaurea (goldenrod) are discussed.

Qin GW, Xu RS. Recent advances on bioactive natural products from Chinese medicinal plants. Med Res Rev 1998;18(6):375-82.
China has accumulated a rich body of empirical knowledge of the use of medicinal plants for the treatment of various diseases throughout its long history. Chemical studies on Chinese medicinal plants provide a valuable material base for the discovery and development of new drugs of natural origin. In this article recent chemical work on various Chinese medicinal plants is reviewed, including Mussaenda pubescens (Rubiaceae), Isatis indigotica (Cruciferae), Euphorbia fischeriana, and E. ebracteolata (Euphorbiaceae), and Stemona species (Stemonaceae). The structural diversity of the medicinal chemical constituents of the above plants is discussed.

Raja D, Blanche C, Valles Xirau J. Contribution to the knowledge of the pharmaceutical ethnobotany of La Segarra region (Catalonia, Iberian Peninsula). J Ethnopharmacol 1997;57(3):149-60.
An ethnobotanical survey was carried out in the region known as La Segarra, situated at the north east of the Iberian Peninsula, in the inner plains of Catalonia, with an area of 720 km2 and a population of 17000. Working with 29 people, data on uses of 142 species belonging to 54 botanical families were obtained and presented, of which 13 uses corresponding to nine plant species were previously unreported.

Rogers MV, Cheek B. Echinacea (purple coneflower). Carol J Pharm 1997 Jan-Feb;77:16.
IPA COPYRIGHT: ASHP The pharmacology, dosage forms, dosage, and toxicity of Echinacea (purple coneflower) for immunostimulation are discussed.

Rogers PL, Shin HS, Wang B. Biotransformation for L-ephedrine production. Adv Biochem Eng Biotechnol 1997;56:33-59.
L-ephedrine is widely used in pharmaceutical preparations as a decongestant and anti-asthmatic compound. One of the key intermediates in its production is L-phenylacetylcarbinol (L-PAC) which can be obtained either from plants (Ephedra sp.), chemical synthesis involving resolution of a racemic mixture, or by biotransformation of benzaldehyde using various yeasts. In the present review, recent significant improvements in the microbial biotransformation are assessed for both fed-batch and continuous processes using free and immobilised yeasts. From previous fed-batch culture data, maximal levels of L-PAC of 10-12 gl-1 were reported with yields of 55-60% theoretical based on benzaldehyde. However, recently concentrations of more than 22 gl-1 have been obtained using a wild-type strain of Candida utilis. This has been achieved through optimal control of yeast metabolism (via microprocessor control of the respiratory quotient, RQ) in order to enhance substrate pyruvate production and induce pyruvate decarboxylase (PDC) activity. Processes involving purified PDC have also been evaluated and it has been demonstrated that L-PAC levels up to 28 gl-1 can be obtained with yields of 90-95% theoretical based on the benzaldehyde added. In the review the advantages and disadvantages of the various strategies for the microbial and enzymatic production of L-PAC are compared. In view of the increasing interest in microbial biotransformations, L-PAC production provides an interesting example of enhancement through on-line control of a process involving both toxic substrate (benzaldehyde) and end-product (L-PAC, benzyl alcohol) inhibition.

Romano I, Tsourounis C. Saw palmetto (Serenoa repens) for the treatment of benign prostatic hyperplasia. Calif J Health Syst Pharm 1998 May-Jun;10:16-7, 33.
IPA COPYRIGHT: ASHP An overview of the pharmacology, pharmacokinetics, clinical studies, and adverse effects of Serenoa repens (Saw palmetto) for the treatment of benign prostatic hyperplasia is presented.

Saller R, Reichling J, Kristof O. [Phytotherapy--treatment without side effects?]. Dtsch Med Wochenschr 1998;123(3):58-62. (Ger)

Schneck C. St. John's wort and hypomania [letter]. J Clin Psychiatry 1998;59(12):689.

Seifert P. Herbal extracts in cosmetics--opportunities and limitations.Seifen Oele Fette Wachse 1997 Jan;123:28, 30-1.
IPA COPYRIGHT: ASHP Various limitations associated with the opportunities for the fashionable use of herbal extracts in cosmetics are briefly discussed, including differences in the criteria for herbal extracts used in cosmetic and medicinal applications, the criteria for natural cosmetics, utility of the drug extract ratio as a measure of the quality or activity of plant extracts, and standardization of plant extracts.

Shaw D. Risks or remedies? Safety aspects of herbal remedies in the UK. J R Soc Med 1998;91(6):294-6.

Shaw D, Leon C, Murray V, Volans G. Patients' use of complementary medicine [letter]. Lancet 1998;352(9125):408.

Shepard GH Jr. Psychoactive plants and ethnopsychiatric medicines of the Matsigenka. J Psychoactive Drugs 1998;30(4):321-32.
For the Matsigenka of the Peruvian Amazon, health and well-being in daily life depend upon harmonious relationships within the social group and with the spirit world. Psychoactive plants play a crucial role in curing disrupted social relationships while giving humans access to the otherwise remote, parallel world of spirits. Different species and cultivars of psychoactive plants, as well as varying admixtures and doses, are used to obtain different intensities and qualities of psychoactive experience, depending upon the individual's goals. Strongly psychoactive plants are used by shamans to travel to the realm of spirits. A number of mild to strongly psychoactive plants are used by male hunters to purify their souls and improve their aim. Mildly psychoactive plants are used to improve women's concentration for spinning and weaving cotton, to control negative emotions such as grief and anger, to manipulate the content of dreams, and to pacify sick or frightened children. A majority of such remedies come from the botanical families of Rubiaceae, Solanaceae and Cyperaceae, known sources of psychoactive compounds. Interdisciplinary research into the culture, botany and pharmacology of psychoactive plants in indigenous medical systems contributes to a better understanding of the role of psychological states in human health and well-being.

Shinchi K, Ishii H, Imanishi K, Kono S. Relationship of cigarette smoking, alcohol use, and dietary habits with Helicobacter pylori infection in Japanese men. Scand J Gastroenterol 1997;32(7):651-5.
BIOSIS COPYRIGHT: BIOL ABS. Background: Little is known of factors determining infection with Helicobacter pylori. Methods: In a cross-sectional study of 566 men aged 50-55 years, who received a preretirement health examination at the Self Defense Forces Fukuoka Hospital between January 1993 and December 1994, we examined the association of smoking, alcohol use, and dietary habits with H. pylori infection. Results: The overall seropositivity as determined with IgG antibody was 79.3% (449 of 566). The rank was inversely associated with the infection (trend, P = 0.048). Neither smoking nor alcohol drinking was related to the infection. The prevalence adjusted for rank tended to be lower in men consuming raw vegetables (trend, P = 0.12) daily than those with less consumption. Unexpectedly, the consumption of tofu (soybean curd) was significantly, negatively related to the infection (trend, P = 0.013). The seropositivity was unrelated to the consumption of pickled vegetables, soy paste soup, green tea, or garlic. Conclusion: The findings suggest that fresh vegetables may be protective against H. pylori infection. The study does not support either an increased risk of the infection associated with salty foods or a protective effect of green tea or garlic.

Square D. Sage advice from my garden. CMAJ 1998;159(12):1495-7.

Stueland DT, Ault BJ, Gunderson PD. Change in cholinesterase levels and self-reported symptoms over two years. J Agromed 1997; 4(1/2):151-6.
The application and reliability of self reported symptoms and serum cholinesterase (ACH) levels as measures of effects of farm chemical exposures over time were analyzed. Twenty two ginseng producers in central Wisconsin participated in 2 years of on site testing. Each year they reported on farming practices and health seeking behavior and completed a 20 item questionnaire related to possible farm chemical exposure symptoms. Plasma and red cell ACH were also measured. No seizure symptoms were reported. The mean age of participants was 41.5 years. Thirteen of the participants were men and 21 were owner operators. The mean initial plasma ACH levels changed from 16.15 units/milliliter (U/ml) in 1994 to 16.25U/ml in 1995. Red blood cell ACH levels were 37.95U/ml in 1994 and 42.32U/ml in 1995 at the start of the season. In 1994 the follow up study showed an increase to 39.55U/ml, but a decrease in 1995 to 38.80U/ml. Changes in symptoms from 1994 to 1995 correlated with the change in initial plasma ACH levels over the same year. Each year the participants experienced a drop in ACH activity. Self reported symptoms remained highly correlated and showed, overall, only minor changes, suggesting that symptoms and ACH testing may be reliable for on site field testing.

Sukumaran M, Chung H, Gollapudi DP. Cultural factors in the treatment of a catatonic Chinese patient [letter]. Gen Hosp Psychiatry 1997;19(5):378-80.

Tello CG, Ford P, Iacopino AM. In vitro evaluation of complex carbohydrate denture adhesive formulations. Quintessence Int 1998;29(9):585-93.
OBJECTIVE: Acemannan, a complex mannose carbohydrate derived from the aloe vera plant, has an inherent stickiness/viscosity. Prototype Acemannan denture adhesive formulations were evaluated for pH changes, cytotoxicity to human gingival fibroblasts and adhesive strength in both dry and wet conditions. METHOD AND MATERIALS: The denture adhesive formulations consisted of five combinations of Acemannan with varying concentrations of preservatives and two other formulations without preservatives. The pH of each formulation was measured over 24 hours. Assessment of cytotoxicity was accomplished using the in vitro, tetrazolium-based colorimetric assay on cultures of human gingival fibroblasts after exposure to the adhesive formulations for up to 24 hours. The adhesive strength was evaluated with a universal testing machine under initial dry conditions and after immersion in a constant-temperature water bath for up to 20 minutes. RESULTS: Formulations 1 and 2 achieved and maintained pH values above 6.0 (the critical pH for hydroxyapatite dissolution) approximately 6 hours into the study. None of the prototypes demonstrated an initial pH above the critical pH. Formulations 1, 2, 3, and 5 exhibited significant cytotoxicity to human gingival fibroblasts over 24 hours. Formulations 4, 20:1, and 150:1 demonstrated minimal cytotoxicity. Formulation 1 exhibited the poorest adhesive strength, while the most viscous formulation (prototype 150:1) was by far the best performer. Generally, adhesive bond strengths for all prototypes were quite high and relatively stable over time in a wet environment. CONCLUSION: To achieve the ideal adhesive in terms of strength, pH, and cytotoxicity, Acemannan formulation 150:1 should be adjusted to contain the preservative concentration of formulation 4 and have an initial pH value of 6.0 or higher.

Thompson CA. As patients embrace herbal remedies, dearth of scientific evidence frustrates clinicians. Am J Health Syst Pharm 1997 Dec 1;54:2656, 2658, 2664.
IPA COPYRIGHT: ASHP Sources of information regarding the efficacy and side effects of herbal remedies for physicians and pharmacists are described, clinical studies evaluating the efficacy of some herbal products are summarized, and differences between formulations of herbal products that may affect the efficacy of the product are discussed.

Thompson CA. USP moves forward in providing information on botanical products [news]. Am J Health Syst Pharm 1998;55(6):527, 530.

Thornton Z. Health care the herbal way. East Pharm 1997 Aug;40:71-2.
IPA COPYRIGHT: ASHP A brief overview of the therapeutic use of herbal medicines is presented, and adverse reactions, self-medication, and the quality control of herbal products are considered.

Turow V. Herbal therapy for children [letter]. Pediatrics 1998;102(6):1492-3.

Van Rensen I, Blume H, Ihrig M, Morck H, Dingermann T, Veit M. [Evaluation of phytopharmaceuticals in pharmacy practice]. Pharm Ztg 1998 Feb 19;143:11-8, 21. (Ger)
IPA COPYRIGHT: ASHP An overview of phytopharmaceuticals, including nomination and standardization of pharmaceutical quality, efficacy, clinical research, therapy study types and designs, safety critiques, terms of registration, and advertisements, is presented; it was noted that patients need the expertise of the counseling pharmacist in regard to herbal medication.

Vann A. The herbal medicine boom: understanding what patients are taking [see comments]. Cleve Clin J Med 1998;65(3):129-34.

Varga CA, Veale DJ. Isihlambezo: utilization patterns and potential health effects of pregnancy-related traditional herbal medicine. Soc Sci Med 1997;44(7):911-24.
Isihlambezo is a herbal decoction used by many Zulu women in South Africa as a preventative health tonic during pregnancy. Though the practice is cited by ethnographers and medical practitioners, few studies have focused on specific elements of isihlambezo use and preparation. Moreover, though some evidence exists suggesting negative effects of its ingestion, the maternal-fetal health impact and toxicity of isihlambezo have not been adequately studied. We examined two aspects of this traditional antenatal health practice: (1) the potential impact of urbanization and access to Western clinic-based care on popularity and utilization patterns of isihlambezo, and (2) the potential maternal-fetal health effects of its use. Interviews were conducted among rural and urban women in clinic and non-clinic settings regarding socio-behavioral aspects of isihlambezo use. The pharmacology of certain plant ingredients of isihlambezo was investigated through laboratory assays, literature review, and interviews with traditional healers. There were significant differences by area of interview in nearly all aspects of isihlambezo use examined. Though isihlambezo was most popular among urbanites and clinic non-attenders, it was considered an important antenatal health care alternative by the majority of women surveyed. Mixing traditional and clinic-based antenatal care was also strongly advocated. Pharmacological analysis suggested the possibility of both therapeutic and harmful consequences of isihlambezo. It was suggested that the following factors might contribute the popularity of isihlambezo among urban women: high cost and inferior quality of clinic care, use of isihlambezo as a means of adapting to urbanization-related stress, and socio-cultural transition.

Vazquez FM, Suarez MA, Perez A. Medicinal plants used in the Barros Area, Badajoz Province, Spain. J Ethnopharmacol 1997;55(2):81-5.
A study of the wild and cultivated medicinal plants used in the Barros Area (southern Spain) is reported, 48 plants distributed among 20 different families are used in the treatment of various human diseases. The use of Bellis annua L. Centaurea ornata Wild., Leuzea conifera (L.) DC., Pulicaria paludosa Link and Asparagus aphyllus L. is reported.

Williamson JS, Wyandt CM. Herbal therapies: facts and the fiction. Drug Top 1997 Aug 4;141:78-87.
IPA COPYRIGHT: ASHP An overview of herbal therapies is presented, including the history of disease treatment with herbal remedies, counseling patients about the appropriate use of herbal products, and the risks and benefits of common herbal remedies such as Medicago sativa (alfalfa), Aloe vera (aloe vera), Arnica montana (arnica), Vaccinium myrtillus (bilberry), Uncaria tomentosa (cat's claw), Angelica sinensis (dong quai), Echinacea purpurea (echinacea), Ephedra sinica (ephedra), Chrysanthemum parthenium (feverfew), Allium sativum (garlic), Ginkgo biloba (ginko biloba), Panax ginseng (ginseng), hypericum perforatum (St. John's wort), and Serenoa repens (saw palmetto). A table of the purported properties and uses of 153 herbs is provided. This article qualifies for 2 hours U.S. CE credit by the ACPE.

Williamson JS, Wyandt CM. Herbal update. Drug Top 1998 Jun 1;142:66-75.
IPA COPYRIGHT: ASHP The rational use and contraindications of herbal therapy, patient information, drug interactions, and the legal status of herbal preparations are presented including popular American and European herbs such as Aloe vera, Arnica montana, Vaccinium myrtillus (bilberry), Uncaria tomentosa (cat's claw), Angelica sinensis (Dong quai), Echinacea purpurea, evening primrose oil, Tanacetum parthenium (feverfew), Allium sativum, Zingiber officinale (ginger), Ginkgo biloba, Panax ginseng, Crataegus species (hawthorn), Aesculus hippocastanum, Piper methysticum (kava-kava), Silybum marianum, Hypericum perforatum (St. John's wort), Serenoa species (Saw palmetto), and Valeriana officinalis (Valerian). This article qualifies for 2 hours U.S. CE credit by the ACPE.

Williamson JS, Wyandt CM. What the pharmacist should know about food and drug interactions. Hosp Pharm Rep 1998 Apr;12:43-52.
IPA COPYRIGHT: ASHP An overview of the effects of food, tobacco, ethyl alcohol, and herbal products on drug action is presented, including a discussion of the mechanisms of drug-food interactions, counseling patients about when it is appropriate to take a drug with food and when it is contraindicated, counseling patients about the effects of alcohol and tobacco use on drug action, and potentially significant food-drug interactions involving nutritional agents, hormonal agents, respiratory agents, diuretics/cardiovascular agents, anti-infective agents, GI agents, CNS agents, antineoplastic agents, immunosuppressive agents, and dietary supplements. This article qualifies for 2 hours U.S. CE credit by the ACPE.

Winkelaar PG. Medicolegal file. Tacit approval of alternative therapy. Can Fam Physician 1999;45:905.

Winston D, Dattner AM. The American system of medicine. Clin Dermatol 1999;17(1):53-6.

Wong HC. Is feverfew a pharmacologic agent? [letter]. CMAJ 1999;160(1):21-2.

Wright R, Vanvuren B. Ginkgo biloba. Nebr Mortar Pestle 1997 Jun;60:10-1.
IPA COPYRIGHT: ASHP An overview of Ginkgo biloba, from a tree native to China and an herbal remedy used for 5000 yr, is presented, including its mechanism of action, therapeutic use in conditions associated with decreased peripheral and cerebral vascularity such as cerebral ischemia, its pharmacodynamics, dosage, adverse effects, and potential drug interactions. It is noted that in Germany and France, Ginkgo biloba is among the most commonly prescribed drugs, while in the United States it is available as an OTC natural product.

Wynn RL, Meiller TF. A brief survey of herbal medicines and other remedies. Gen Dent 1997;45(2):112-5.

Xue T, Zhang L. Avenues of discovery in bioprospecting [letter; comment]. Nature 1998;393(6686):617.

Zhang YY, Don HY, Guo YZ, Ageta H, Harigaya Y, Onda M, Hashimoto K, Ikeya Y, Okada M, Maruno M. Comparative study of Scutellaria planipes and Scutellaria baicalensis. Biomed Chromatogr 1998;12(1):31-3.
Scutellaria planipes, a species of Scutellaria, was explored by comparing to Scutellaria baicalensis, a pharmacopoeia species. Four principle flavonoids in both the plant roots were analyzed by using a reversed-phase chromatographic system with a chemically bonded ODS silica gel column and phosphate buffer:methanol (68:32 and 1:1) as mobile phase. Their contents were similar in both plant roots. Antiallergic and antibacterial activities in vitro and acute toxicity were compared. The results provided valuable data for S. planipes as a potential medicinal resource.

Zink T, Chaffin J. Herbal 'health' products: what family physicians need to know [see comments]. Am Fam Physician 1998;58(5):1133-40.
Patients who self-medicate with herbs for preventive and therapeutic purposes may assume that these products are safe because they are "natural," but some products cause adverse effects or have the potential to interact with prescription medications. The United States lacks a regulatory system for herbal products. Although only limited research on herbs has been published, St John's wort shows promise as a treatment for depression. Ginkgo biloba extract is possibly effective for cerebrovascular insufficiency and dementia. Feverfew is used extensively in Canada for migraine prophylaxis but needs more rigorous study. Ephedrine has been regulated by many states because its misuse has been associated with several deaths. Echinacea is being tried as an agent for immune stimulation, and garlic is under study for cholesterol-lowering properties, but both require more study. Physicians should educate themselves and their patients about the efficacy and adverse interactions of herbal agents and the limitations of our present knowledge of them.

. Phytotherapy: how to minimize risks. Presc Intl 1997;6(27):25-6.
IPA COPYRIGHT: ASHP Various ways to minimize risks associated with herbal remedy therapies are described, including an overview of adverse effects associated with various herbal remedies, the need for health professionals to be aware of unreliable labels on plant based products as well as contamination potential, and the levels of regulatory control that exist on herbal remedies in France.

. Pulmonary embolism with a plant based product. Presc Intl 1997;6(31):144.
IPA COPYRIGHT: ASHP The removal of a plant based formulation from the market in France following its implication in a case of deep vein thrombosis and pulmonary embolism in an infant, and the importance of removing herbal products with no guarantees of efficacy and safety from pharmacy shelves are briefly discussed.

Abdel-Hafez AA, Meselhy MR, Nakamura N, Hattori M, Watanabe H, Murakami Y, El-Gendy MA, Mahfouz NM, Mohamed TA. Effects of paeoniflorin derivatives on scopolamine-induced amnesia using a passive avoidance task in mice; structure-activity relationship. Biol Pharm Bull 1998;21(11):1174-9.
Paeoniflorin (1) and its derivatives having in common a cage-like pinane skeleton with hemiketal-acetal system, were evaluated for their effects on memory impairment induced by scopolamine in mice using a step-down type passive avoidance task. In the test session, 1 and its derivatives were intraperitoneally (i.p.) administered at doses of 0.002, 0.01, 0.02 and 0.2 mmol/kg, and 30 min later (15 min before the experiment), scopolamine (1 mg/kg, i.p.) was given. These compounds showed dose-dependent attenuation in a dose range of 0.002-0.02 mmol/kg and also enhancement of scopolamine-induced decrease in step-down latency. The effects of these compounds, except that of 2',3',4',5'-O-tetraacetyl-3-O-methylpaeoniflorin (8), followed a bell-shaped dose response profile. 8-Debenzoyl-6-deglucosyl-3-O-methylpaeoniflorin (6) showed no significant increase in the step-down latency at all tested doses. Maximum step-down latency was obtained by 3-O-methylpaeoniflorin (3) and 2',3,3',4',5'-penta-O-methylpaeoniflorin (7) (the minimal effective dose was 0.002 mmol/kg). Relative to 3, debenzoylation, as in 8-debenzoyl-3-O-methylpaeoniflorin (4), slightly increased the latency, while deglucosylation, as in 6-deglucosyl-3-O-methylpaeoniflorin (5), significantly reduced the prolongation of latency. Removal of both glucose and benzoyl moieties resulted in the loss of activity as seen in 6. These results revealed that, in addition to the cage-like pinane skeleton, the benzoyl and the glucosyl moieties are important structural elements of the paeoniflorin skeleton as its effects on scopolamine-induced amnesia.

Al-Fakhri SA. Herbal medicine: possible cause of aspiration pneumonia: case report. Saudi Pharm J 1998;6(1):88-91.
IPA COPYRIGHT: ASHP The case report of a 3-wk-old girl who developed aspiration pneumonia possibly due to aspiration of an herbal medicine in powder form consisting of Commiphora molmol (myrrh), Ferula foetida L. (apiacea), Astragalus sarcocolla, and Saccharum officinarum Linne. is presented. The child was successfully treated with nebulized albuterol (salbutamol) and budesonide and oral prednisolone.

Al-Suwaidan SN, Gad El Rab MO, Al-Fakhiry S, Al Hoqail IA, Al-Maziad A, Sherif AB. Allergic contact dermatitis from myrrh, a topical herbal medicine used to promote healing. Contact Dermatitis 1998;39(3):137.

Aldana L, Gonzalez De Mejia E, Craigmill A, Tsutsumi V, Armendariz-Borunda J, Panduro A, Rincon AR. Cypermethrin increases apo A-1 and apo B mRNA but not hyperlipidemia in rats. Toxicol Lett 1998;95(1):31-9.
The hepatotoxic effect of cypermethrin and the expression of hepatic genes at the mRNA level, as molecular markers of liver damage, were evaluated in rats following exposure to cypermethrin. The expression of hepatic genes was compared with conventional liver functional tests, and correlations were made by studying the liver at the ultrastructural level. Cypermethrin treated rats presented a significant decrease, of 79% and 22%, on the expression of albumin and apo E genes at 5 days, respectively. The levels of apo A-1 and apo B mRNA were increased up to four- and fivefold, respectively. This increase did not correlate with the serum values of HDL and VLDL lipoprotein particles. Intracytoplasmic lipid droplets were observed after the first 2 days following cypermethrin administration, suggesting that apo A-1 and B mRNA were translated but not secreted. There were significant correlations between the low values of the albumin gene expression, the decrease in the HDL concentrations, and the ultrastructural alterations, respectively. These alterations were mainly a large amount and increased size of mitochondria in the animals exposed to cypermethrin. It is concluded that under the experimental conditions used, cypermethrin may alter the metabolism of lipids and proteins in rat liver.

Alexander RG, Wilson DA, Davidson AG. Medicines Control Agency investigation of the microbial quality of herbal products. Pharm J 1997 Aug 16;259:259-61.
IPA COPYRIGHT: ASHP To assess the microbiological quality of licensed herbal products by determining the nature and quantity of microorganisms present, 425 herbal products were examined by pharmacopeial and validated inhouse methods; total aerobic bacterial counts and total fungal counts were measured. Most licensed herbal products were found to comply with European Pharmacopeial limits. However, some solid oral dosage forms were found to contain undesirable organisms. It was suggested that additional quantitative tests for specific microorganisms in future editions of the European Pharmacopeia may be justified.

Alpertunga B, Omurtag GZ, Ozmentese N. Investigation about the genotoxic activities of some herbal teas used as folk medicine. Acta Pharm Turc 1997;39(3):105-10.

Ameri A. The effects of Aconitum alkaloids on the central nervous system. Prog Neurobiol 1998;56(2):211-35.
Preparations of Aconitum roots are employed in Chinese and Japanese medicine for analgesic, antirheumatic and neurological indications. The recent surge in use of phytomedicine derived from traditional Chinese medicine as well as increasing concerns about possible toxic effects of these compounds have inspired a great deal of research into the mechanisms by which certain Aconitum alkaloids may act on the central nervous system. The pharmacological effects of preparations of Aconitum roots are attributed to several diterpenoid alkaloids. The main alkaloid of these plants is aconitine, a highly toxic diterpenoid alkaloid which is known to suppress the inactivation of voltage-dependent Na+ channels by binding to neurotoxin binding site 2 of the alpha-subunit of the channel protein. In this article the pharmacology of several structurally related Aconitum alkaloids is highlighted and their therapeutic vs toxic potential is discussed. Neurochemical and neurophysiological studies will be reviewed with emphasis on the effects of the alkaloids in regions of the brain that have been implicated in pain transmission and generation of epileptic activity. Considering the chemical structure of the Aconitum alkaloids as well as their mechanism of action, a subdivision in three groups becomes obvious: the first group comprises such alkaloids which possess high toxicity due to two ester boundings at the diterpene skeleton. The members of this group activate voltage-dependent sodium channels already at resting potential and inhibit noradrenaline reuptake. Activation of sodium channels and in consequence excessive depolarization with final inexcitability and suppression of pain transmission account for their antinociceptive properties. The second group comprises less toxic monoesters which have been shown to possess strong antinociceptive, antiarrhythmic and antiepileptiform properties due to a blockade of the voltage-dependent sodium channel. Electrophysiological studies have revealed a use-dependent inhibition of neuronal activity by these alkaloids. They seem to be competitive antagonists of the group I-alkaloids. The third group of Aconitum alkaloids are lacking an ester side chain in the molecule. Toxicity is markedly reduced when compared with the two other groups. They fail to affect neuronal activity, but are reported to have antiarrhythmic actions suggesting that they may have different affinities to various subtypes of the alpha-subunit of the Na+ channel in brain and heart.

Angell M, Kassirer JP. Alternative medicine--risks of untested and unregulated remedies. N Engl J Med 1998 Sep 17;339:839-41.
IPA COPYRIGHT: ASHP The risks of untested and unregulated herbal medicine, the most common of all forms of alternative medicine, are discussed.

Anibarro B, Fontela JL, De La Hoz F. Occupational asthma induced by garlic dust. J Allergy Clin Immunol 1997;100(6 Pt 1):734-8.
BACKGROUND: Garlic dust has not been a frequently encountered cause of IgE-mediated disease. OBJECTIVE: We report on 12 patients (all of them garlic workers) with the clinical criteria for occupational asthma. METHODS: Skin prick tests and serum-specific IgE determinations were performed with common inhalants, garlic, and other members of the Liliaceae family (onion, leek, and asparagus). Bronchial challenge test with garlic powder was performed in all patients. Garlic and onion extract proteins were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis. Immunoblot and IgE immunoblot inhibition analyses were performed with patients' sera on extracts of garlic, onion, and pollens of Phleum pratense and Chenopodium album. RESULTS: Garlic sensitization was demonstrated by bronchial challenge test in seven patients (group 1) and ruled out in the remaining five (group 2). Clinical data were similar in both groups. The patients with garlic allergy had a mean age of 27 years, and all of them had pollen allergy; sensitization to other members of the Liliaceae family was also common. Electrophoresis of garlic extract revealed two major protein bands at approximately 12 and 54 kd. During IgE immunoblotting, the pool of sera reacted with garlic proteins mainly at 54 kd. Preincubation with onion, Phleum, and Chenopodium partially abolished the IgE binding to several allergens of garlic. CONCLUSION: We report on seven patients in whom an occupational garlic allergy was demonstrated. Garlic allergy is relatively rare but seems to affect young subjects with pollen allergy, and sensitization to other members of the Liliaceae family is common. The results of this study confirm the presence of some structurally similar allergens in garlic, onion, and certain pollens.

Aphale AA, Chhibba AD, Kumbhakarna NR, Mateenuddin M, Dahat SH. Subacute toxicity study of the combination of ginseng (Panax ginseng) and ashwagandha (Withania somnifera) in rats: a safety assessment. Indian J Physiol Pharmacol 1998;42(2):299-302.
Ginseng (Panax ginseng) and Ashwagandha (Withania somnifera) are widely used as geriatric tonics. Both individually have not shown any toxicity on long term administration. Study was planned to assess the safety of the combination by doing subacute toxicity study in rats with 90 days oral administration using three doses. Food consumption, body weight, haematological, biochemical and histopathological parameters were studied. There was significant increase in body weight, food consumption and liver weight, and improved hematopoiesis was observed. Brain, heart, lung, liver, spleen, kidneys, stomach, testis and ovaries were normal on gross examination and histopathologically. Subacute toxicity studies in rats did not reveal any toxicity.

Apted J. Primin sensitivity in a patient sensitive to Streptocarpus [letter]. Australas J Dermatol 1998;39(3):199-200.

Asero R. Relevance of pollen-specific IgE levels to the development of Apiaceae hypersensitivity in patients with birch pollen allergy. Allergy 1997;52(5):560-4.
A large clinical/serologic study was carried out to determine the prevalence of Apiaceae (carrot, celery, and fennel) hypersensitivity in patients with birch pollen allergy, and to investigate its relationship with apple and hazelnut allergy and with birch pollen-specific IgE levels. A total of 196 birch pollen-hypersensitive patients with oral allergy syndrome (OAS) caused by different vegetable foods were examined in the cross-sectional part of the study. Of this total, 195 patients had apple and/or hazelnut allergy, and 103 had Apiaceae sensitivity; only one patient had Apiaceae allergy alone. Apiaceae-positive patients showed significantly higher birch pollen-specific IgE levels than negative ones (median 13 vs 7 AU/ml; P < 0.0001). The prospective part of the study was performed on 103 birch pollen-hypersensitive patients who were OAS-free at the time of the first visit and were periodically followed-up for OAS. Patients who developed Apiaceae sensitivity showed much higher birch-specific IgE levels than patients who developed apple/hazelnut allergy only (median 15.5 vs 8.5 AU/ml; P < 0.05), whereas those who remained OAS-free showed the lowest specific IgE levels (median 5 AU/ml). This study suggests that most Apiaceae determinants cross-react with apple or hazelnut determinants, whereas only some apple or hazelnut determinants cross-react with Apiaceae-allergenic determinants; moreover, it shows that birch-specific IgE levels heavily influence the onset of OAS as a whole, and probably play a critical role in the development of allergies to distinct vegetable foods as well.

Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of garlic allergy. J Allergol Clin Immunol 1998;101(3):427-28.
BIOSIS COPYRIGHT: BIOL ABS. RRM CASE STUDY ALLIUM-SATIVUM HUMAN ADULT FEMALE GARLIC ALLERGY ALLERGY URTICARIA DERMATOLOGY IMMUNE SYSTEM DISEASE INTEGUMENTARY SYSTEM DISEASE.

Avila H, Rivero J, Herrera F, Fraile G. Cytotoxicity of a low molecular weight fraction from Aloe vera (Aloe barbadensis Miller) gel. Toxicon 1997;35(9):1423-30.
The cytotoxicity of a low mol. wt fraction (LMWF) obtained from Aloe vera gel was determined by two different assays. Firstly, exposure of monolayers of chicken fibroblasts to LMWF induced disruption of intercellular junctions and detachment of individual cells from the bottom of the flask, with formation of cell-free gaps in the monolayer. Secondly, LMWF inhibited the production of reactive oxygen species by human polymorphonuclear leukocytes stimulated by zymosan, as followed by luminol-dependent chemiluminescence. The toxic activity of LMWF was compared to that of sodium dodecyl sulfate (a well-known toxic substance), aloe-emodin and aloin (an anthraquinone and its precursor present in Aloe vera cortex) using the chemilumescence assay, and was found to be of similar potency to these toxic substances on a weight-to-weight basis. These results confirm that Aloe vera gel contains toxic low mol. wt compounds, and every effort must be made to limit the amount of these toxins in the commercially prepared Aloe vera gel products.

Bagheri H, Broue P, Lacroix I, Larrey D, Olives JP, Vaysse P, Ghisolfi J, Montastruc JL. Fulminant hepatic failure after herbal medicine ingestion in children [letter]. Therapie 1998;53(1):82-3.

Barnes J, Mills SY, Abbot NC, Willoughby M, Ernst E. Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: face-to-face interviews with 515 users of herbal remedies. Br J Clin Pharmacol 1998;45(5):496-500.
AIMS: To determine whether adverse drug reactions (ADRs) to herbal remedies would be reported differently from similar ADRs to conventional over-the-counter (OTC) medicines by herbal-remedy users. METHODS: Face-to-face interviews (using a structured questionnaire) with 515 users of herbal remedies were conducted in six pharmacy stores and six healthfood stores in the UK. The questionnaire focused on the likely course of action taken by herbal-remedy users after experiencing an ADR associated with a conventional OTC medicine and a herbal remedy. RESULTS: Following a 'serious' suspected ADR, 156 respondents (30.3%) would consult their GP irrespective of whether the ADR was associated with the use of a herbal remedy or a conventional OTC medicine, whereas 221 respondents (42.9%) would not consult their GP for a serious ADR associated with either type of preparation. One hundred and thirty-four respondents (26.0%) would consult their GP for a serious ADR to a conventional OTC medicine, but not for a similar ADR to a herbal remedy, whereas four respondents (0.8%) would consult their GP for a serious ADR to a herbal remedy, but not for a similar ADR to a conventional OTC medicine. Similar differences were found in attitudes towards reporting 'minor' suspected ADRs. CONCLUSIONS: Consumers of herbal remedies would act differently with regard to reporting an ADR (serious or minor) to their GP depending on whether it was associated with a herbal remedy or a conventional OTC medicine. This has implications for herbal pharmacovigilance, particularly given the increasing use of OTC herbal remedies. The finding that a high proportion of respondents would not consult their GP or pharmacist following ADRs to conventional OTC medicines is also of concern.

Bateman J, Chapman RD, Simpson D. Possible toxicity of herbal remedies. Scott Med J 1998;43(1):7-15.
Herbal remedies are rapidly gaining popularity throughout the world as a result of dissatisfaction with conventional medicines. It is a widely held belief that herbal preparations are "natural" and are therefore intrinsically harmless. However, their effects can be very powerful and potentially lethal if used incorrectly and their use as a substitute for conventional medicines may be ineffective. Toxic effects have been attributed to several factors including hepatotoxicity of main constituents, contamination of preparations by heavy metals or microorganisms, and adverse reactions due to age, and genetic and concomitant disease characteristics of the user.

Bernd A, Simon S, Ramirez Bosca A, Kippenberger S, Diaz Alperi J, Miquel J, Villalba Garcia JF, Pamies Mira D, Kaufmann R. Phototoxic effects of Hypericum extract in cultures of human keratinocytes compared with those of psoralen. Photochem Photobiol 1999;69(2):218-21.
Extracts of Hypericum perforatum (St. John's wort) are used in the treatment of depression. They contain the plant pigment hypericin and hypericin derivates. These compounds have light-dependent activities. In order to estimate the potential risk of phototoxic skin damage during antidepressive therapy, we investigated the phototoxic activity of hypericin extract using cultures of human keratinocytes and compared it with the effect of the well-known phototoxic agent psoralen. The absorbance spectrum of our Hypericum extract revealed maxima in the whole UV range and in parts of the visible range. We cultivated human keratinocytes in the presence of different Hypericum concentrations and irradiated the cells with 150 mJ/cm2 UVB, 1 J/cm2 UVA or 3 h with a white light of photon flux density 2.6 mumol m-2 s-1. The determination of the bromodeoxyuridine incorporation rate showed a concentration- and light-dependent decrease in DNA synthesis with high hypericin concentrations (> or = 50 micrograms/mL) combined with UVA or visible light radiation. In the case of UVB irradiation a clear phototoxic cell reaction was not detected. We found phototoxic effects even with 10 ng/mL psoralen using UVA with the same study design as in the case of the Hypericum extract. These results confirm the phototoxic activity of Hypericum extract on human keratinocytes. However, the blood levels that are to be expected during antidepressive therapy are presumably too low to induce phototoxic skin reactions.

Betz JM, Andrzejewski D, Troy A, Casey RE, Obermeyer WR, Page SW, Woldemariam TZ. Gas chromatographic determination of toxic quinolizidine alkaloids in blue cohosh Caulophyllum thalictroides (L.) Michx. Phytochemical Analysis 1998;9(5):232-6.
BIOSIS COPYRIGHT: BIOL ABS. Blue cohosh (Caulophyllum thalictroides (L.) Michx., Berberidaceae) is a North American perennial herb which is found as an ingredient in dietary supplement products in the United States. The plant contains the alkaloids N-methylcytisine, baptifoline, anagyrine and magnoflorine. Some of the alkaloids, including the quinolizidine alkaloid anagyrine, are toxic to range animals and have been implicated as teratogens in higher animals. Since the traditional use of the herb involves administration to women of reproductive age to treat menstrual cramps, and to pregnant women la the last 3-4 weeks of pregnancy to ease parturition, therefore the safety of these products to the fetus is of concern. Three of these alkaloids have been determined in authentic blue cohosh and several dietary supplements. Levels found were: 5-850 ppm for N-methylcytisine, 2-390 ppm for anagyrine, and 9-900 ppm for baptifoline. The lower alkaloid concentrations were found in products containing liquid extracts. Alkaloid identities were confirmed by mass spectrometry.

Bieler CA, Stiborova M, Wiessler M, Cosyns JP, Van Ypersele De Strihou C, Schmeiser HH. 32P-post-labelling analysis of DNA adducts formed by aristolochic acid in tissues from patients with Chinese herbs nephropathy. Carcinogenesis 1997;18(5):1063-7.
Recently, we reported that aristolochic acid (AA) a naturally occurring nephrotoxin and carcinogen is implicated in a unique type of renal fibrosis, designated Chinese herbs nephropathy (CHN). Indeed, we identified the principal aristolochic acid-DNA adduct in the kidney of five such patients. We now extend these observations and demonstrate the presence of additional AA-DNA adducts by the 32P-post-labelling method not only in the kidneys, but also in a ureter obtained after renal transplantation. Using the nuclease P1 version of the assay not only the major DNA adduct of aristolochic acid, 7-(deoxyadenosin-N6-yl)-aristolactam I (dA-AAI), but also the minor adducts, 7-(deoxyguanosin-N2-yl)-aristolactam I (dG-AAI) and 7-(deoxyadenosin-N6-yl)-aristolactam II (dA-AAII) were detected, and identified by cochromatographic analyses with TLC and HPLC. Quantitative analyses of six kidneys revealed relative adduct levels from 0.7 to 5.3/10(7) for dA-AAI, from 0.02 to 0.12/10(7) for dG-AAI and 0.06 to 0.24/ 10(7) nucleotides for dA-AAII. The detection of the dA-AAII adduct is consistent with the occurrence of aristolochic acid II (AAII) in the herb powder imported under the name of Stephania tetrandra and confirms that the patients had indeed ingested the natural mixture of AAI and AAII. 32P-post-labelling analyses of further biopsy samples of one patient showed the known adduct pattern of AA exposure not only in the kidney, but also in the ureter, whereas in skin and muscle tissue no adduct spots were detectable. In an attempt to explain the higher level of the dA-AAI adduct compared to the dG-AAI adduct level in renal tissue even 44 months after the end of regimen, the persistence of these two purine adducts was investigated in the kidney of rats given a single oral dose of pure AAI. In contrast to the dG-AAI adduct, the dA-AAI adduct exhibited a lifelong persistence in the kidney of rats. Our data demonstrate that AA forms DNA adducts in human tissue by the same activation mechanism(s) reported from animal studies. Thus, the carcinogenic/mutagenic activity of AA observed in animals could also be responsible for the urothelial cancers observed in two of the CHN patients.

Blanc PD, Kuschner WG, Katz PP, Smith S, Yelin EH. Use of herbal products, coffee or black tea, and over-the-counter medications as self-treatments among adults with asthma. J Allergy Clin Immunol 1997;100(6 Pt 1):789-91.
BACKGROUND: There are few data on the use of alternative therapies in adult asthma and their impact on health outcomes. OBJECTIVE: The objective of this study was to study the prevalence and morbidity of asthma self-treatment with herbs, coffee or black tea, and over-the-counter (OTC) medications containing ephedrine or epinephrine. METHODS: We carried out a cross-sectional analysis of interview data for 601 adults with asthma recruited from a random sample of pulmonary and allergy specialists. We estimated the 12-month prevalence of reported use of herbal products, coffee or black tea, or OTC products to self-treat asthma and their association with emergency department visits and hospitalization. RESULTS: Herbal asthma self-treatment was reported by 46 (8%; 95% confidence interval [CI] 6% to 10%); coffee or black tea self-treatment by 36 (6%; 95% CI 4% to 8%), epinephrine or ephedrine OTC use by 36 (6%; 95% CI 4% to 8%), and any of the three practices by 98 subjects (16%; 95% CI 13% to 19%). Adjusting for demographic and illness covariates, herbal use (odds ratio [OR] 2.5; 95% CI 1.1 to 5.6) and coffee or black tea use (OR 3.1; 95% CI 1.2 to 7.8) were associated with asthma hospitalization; OTC use was not (OR 0.8; 95% CI 0.3 to 2.5). CONCLUSIONS: Even among adults with access to specialty care for asthma, self-treatment with nonprescription products was common and was associated with increased risk of reported hospitalization. This association does not appear to be accounted for by illness severity or other disease covariates. It may reflect delay in utilization of more efficacious treatments.

Borins M. The dangers of using herbs. What your patients need to know. Postgrad Med 1998;104(1):91-5, 99-100.
Herbal remedies are becoming increasingly popular among patients as treatment for such varied medical problems as arthritis, depression, diabetes, menstrual irregularity, and pulmonary conditions. However, there are many negative effects of herbal preparations. Dr Borins discusses the potential side effects of various herbs and the lack of standardization and control that can contribute to contamination and toxicity of herbal products.

Bove GM. Acute neuropathy after exposure to sun in a patient treated with St. John's Wort. Lancet 1998 Oct 3;352:1121-2.
IPA COPYRIGHT: ASHP The case of a 35-yr-old woman who took 500 mg of Hypericum perforatum as a ground preparation daily for mild depression, based on information in a magazine article, and developed subacute polyneuropathy after exposure to the sun is presented. After 4 wk of taking H. perforatum, the patient developed stinging pain on her face and the dorsum of each hand, which were areas that had received sun exposure. She sought help when the same symptoms developed on the exposed areas of her arms and legs a few h after sunbathing. The patient was diagnosed with subacute toxic neuropathy. H. perforatum was stopped. The symptoms began to improve after 3 wk and disappeared gradually over the next 2 months.

Boyle FM. Adverse interaction of herbal medicine with breast cancer treatment [letter; comment]. Med J Aust 1997;167(5):286.

Brockmoller J, Reum T, Bauer S, Kerb R, Hubner WD, Roots I. Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry 1997;30(Suppl 2):94-101.
Extracts of St. John's wort (Hypericum perforatum) are used in treatment of depression. They contain various substances with the naphthodianthrones hypericin and pseudohypericin as characteristic ingredients. These compounds were shown to cause phototoxicity in cell culture and in animals. A placebo-controlled randomized clinical trial with monitoring of hypericin and pseudohypericin plasma concentration was performed to evaluate the increase in dermal photosensitivity in humans after application of high dose hypericum extracts. The study was divided into a single dose and a multiple dose part. In the single dose period, each of 13 volunteers received in a double blind fourfold complete crossover design, either placebo, or 900, 1800 or 3600 mg of a standardized hypericum extract (LI 160) containing zero, 2.81, 5.62 and 11.25 mg of total hypericin (total hypericin is the sum of hypericin and pseudohypericin). Maximum total hypericin plasma concentrations were observed about 4 h after dosage and were 0, 0.028, 0.061 and 0.159 mg/L, respectively. Before and 4 h after drug intake, the subjects were exposed at small areas of their back to increasing doses of solar simulated irradiation (SSI, with combined ultraviolet A, UV-A, and UV-B light) and another part was exposed to selective UV-A light irradiation. Minimal erythema dose was det