Herbal pharmacology and Drug interaction of TCM Dr. Baisong Zhong M.D(China), Ph.D, L.Ac. WWW: Painandacupuncture.netfirms.com E-mail: [e-mail]

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Herbal pharmacology and Drug interaction of TCM
Dr. Baisong Zhong M.D(China), Ph.D,
L.Ac. WWW Painandacupuncture.netfirms.comE-mail
Painandacupncture_at_yahoo.com
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• 
  Preface
• In 2002, sales of herbs/botanical supplements
  increased to an estimated 4.3 billion per year
• From 2001 to 2003, herbal products for women
  increased by approximately 25
• In 2005, a secondary analysis of the
  complementary and alternative medicine (CAM)
  supplement to the 2002 National Health Interview
  Survey (NHIS)2,3 estimated that more than 38
  million Americans use herbs and dietary
  supplements. More recent estimates have placed
  this number as high as 60 million.
• http//nccam.nih.gov

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Chapter 1 Introduction to Pharmacology of TCM

•  1.Concept of Pharmacology of TCM
• Pharmacology of TCM is the study of the actions,
  usage, mechanism and adverse effects of TCM
  (includes acupuncture, herbs, qigong, tui-na, TCM
  theory, etc.) with modern scientific methods.
• 2. Tasks of Pharmacology of TCM
• (1)   Research the functions of TCM
• (2)   Research how TCM acts on the human body
• (3) Research why TCM has those functions

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• In this course, we will only be studying the
  herbal pharmacology of TCM. (HTCM)
• 3. History and Development of HTCM
• 4. Research Methodology of HTCM
• (1)   To analyze the chemical structures of TCM
  herbs, and to purify the active structures or
  even to synthesize them. Then, to put them into
  clinical trials methodically after understanding
  their pharmacology and toxicology
• (2)   To research HTCM according to the theory of
  TCM
•       i. To explain the crux of TCM according to
  formula theory
•       ii. To research TCM syndromes through
  animal experiments.
•      iii. To research the behaviors,
  characteristics and properties of the herbs in
  complex TCM formulas.
• iv. To help discover new patent herbs or
  formulas
•                      

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• Research Methodology of HTCM
• in vitro studies
• animal studies
• clinical studies

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•  
• 5 Tastes of HTCM
• (1)   Pungent Herbs
•   i. Herbs that relieve exterior syndrome
• They mainly contain volatile oils that
• o       Promote sweating
• o       Improve microcirculation
• o       Are anti-bacterial
• o       Are anti-viral
  exterior syndrome
• o       Stimulate appetite
• o       Relax spasm
• o       Relieve pain

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•    
•   ii.      Herbs that regulate qi
• They mainly contain volatile oils that
• o       Regulate digestive function
• o       Activate smooth muscle
• o       Help secretion of digestive juice
• o       Stimulate appetite
• o       Relax spasm
• o       Relieve pain

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• (2)   Sweet Herbs
• Most of them are rich in nutrition (amino acid,
  sugar, glycoside). Some of them can improve
  immune function.
• (3)   Bitter Herbs
• They are rich in alkaloid and glycoside that are
  anti-bacterial, anti-viral and anti-inflammatory
  (Huang Lian has berberine).
• (4)   Sour Herbs
• They are rich in tannic acid and organic acids
  that have strong astringent action.
• (5)   Salty Herbs
• They contain iodine and inorganic salts.

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•  6. Acute Toxic Test of Herbs
• Lethal Dose 50 or LD 50 is determined and defined
  as that dose of a drug which kills 50of the
  animals to which it is administered. The concept
  of LD50 suggests that if a whole population
  (rather than just an experimental sample) were
  exposed to this dose (which is actually the
  median lethal dose), 50 of the population would
  live and 50 would die.
•  
• 7. Long Term Toxic Test of Herbs about half a
  year
• e.g. Chuan Wu and Ma Qian Zi have toxic effect on
  the heart, and Mu Tong, and Guang Fang Ji have
  toxic effect on the kidney.

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• Chapter 2 Herbs that Relieve Exterior Syndromes
• Properties of HRES
• 1. Inducing sweating
• 2. Abating fever
• (1)   Induce sweating
• (2)   Dilate blood vessels of skin
• (3)   Decrease cAMP in brain
• (4)   Disturb the synthesis of prostaglandin E
• (5)   Is anti-inflammatory
• (6)   Treat the cause of fever by means of
  anti-bacteria
• Having analgesic action

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• 4.Regulating immune function and
  anti-inflammation
• 5.Being anti-anaphylaxis
• 6.Being anti-bacterial and anti-viral
• 7.Having anti-tissue and expectorant action, and
  anti-asthma action
•  

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• Questions?
• What kinds of actions do the 5 tastes have?

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•      Ma Huang (Ephedra)
• Main Components
• 1.      L-ephedrine
• 2.      D-pseudo-ephedrine
• Effects HTCM
• Inducing sweating
• (1)   Reduce sweat glands ability to re-absorb
  sodium (Na, increases the crystal osmotic
  pressure) and thus increase sweating
• (2)   Stimulate CNS and a receptor(? )
• Relieving asthma

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• (1)   Stimulate adrenergic nerve to release
  adrenaline
• (2)   Lead to a rise in intraccelluor cAMP
  levels, make subsequent bronchial smooth muscle
  relax
• (3)   Prevent to release powerful inflammation
  mediators
• Inducing diuresis
• (1)   Dilate potassium ion (K) channel of renal
  tubule and improve blood circulation
• (2)   Prevent renal tubule from re-absorbing
  sodium

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• 4. Having anti-inflammatory and anti-allergenic
  reaction
• 5.Stopping cough and expectorating
• 6.Reducing fever, being anti-bacterial and
  anti-viral
• 7.Exciting CNS
• 8. Stimulating heart increasing blood
  pressure(?1?1)
• Indications
• Bronchial asthma
• Stuffy nose
• Low blood pressure
• Urticaria.

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• Side Effects
• 1. Lead to bleeding of eyes
• 2. ON nervous and cardiac system(egMDMA,
  CRYSTAL METH?CRYSTAL?SHABU?GLASS?BASE.
  EgNervousness, anxiety, palpitations, headaches,
  nausea, hypertension, seizures, strokes,
  myocardial infarction, hyperthermia, and death
  have been reported. )
• 3. Lead to restlessness, insomnia
• Interaction
• 1. avoid with medication that are for lowing
  blood pressure
• 2. avoid with medication that are for
  promoting sweats

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Adverse Effects

• 1.Nervousness, anxiety, palpitations, headaches,
  nausea, hypertension, seizures, strokes,
  myocardial infarction, hyperthermia, and death
  have been reported.
• 2.Myocardial ischemia and infarction,
  dysrhythmias, and uncontrolled hypertension have
  been reported following consumption of ephedra
• 3.This may be caused by increased oxygen demand
  of the myocardium in persons with pre-existing
  arteriosclerotic heart disease who ingest this
  substance
• 4.Reports of cerebral vascular ischemia,
  intracranial hemorrhage, and central nervous
  system vasculitis have all been reported in
  association with the ingestion of ephedra.
  Seizures have also been associated with its use.
  Ephedra extracts have been shown to be toxic to
  specific neuronal cell lines.
• 5.Acute psychosis has been linked with ephedra
  usage.

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• Gui Zhi (Cinnamon twig, cinnamomun)
• Main Components
• cinnamic aldehyde
• cinnamic acid
• phenylpropyl acetate (few)
• Effects HTCM
• Dilating blood vessels to promote sweating
• Cinnamic aldehyde can help blood flow to skin,
  especially with ephedra
• Reducing fever stopping pain
• This action is related to promoting sweating.
• It can increase the ability of enduring pain(pain
  threshold).

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• Tranquilizing can anti- convulsion.
• Being anti-inflammatory and anti-allergic
• Being anti-bacterial (staphylococcus aureus,
  pneumococcus) and anti-viral (influenza virus)
• It can be anti-staphylococcus aureus, anti-TB.
• It can be anti-ECHO11 (V.).
• Indications
• Side Effects

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•    Chai Hu (Bupleurum Root)
• It is bitter in flavor, slightly cold in nature,
  and acts on liver and gallbladder
• Main Components
• Saiko-side a, b, c and d
• a-spinastral
• Volatile oil
• Fatty acid
• Effects HTCM
• Abate fever. The dosage size of bupleurum root is
  directly proportional to its effectiveness in
  lowering fevers due to typhoid bacillus and
  colibacillus. Saiko-side and volatile oil have
  the fever abating effect.

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• 2.Tranquilize, has analgesic effect, and stop
  cough. The saiko-side has this effect but is less
  potent than codeine.
• 3.Promote immune function. It can strengthen the
  action of Kupffers cell and NK cell.
• 4.Protect liver, cholagogize (benefiting the
  gallbladder) and lower cholesterol. The
  saiko-side has this effect. Bupleurum root
  prepared with vinegar is more effective in
  lowering cholesterol (especially for
  triglyceride)
• 5.Treat digestive ulcer. The saiko-side can
  prevent the mucosa of the stomach from being
  impaired by acid and alcohol.
• 6.Relax the spasm of intestinal muscles.

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• Indications
• TCM
• Alternate fever and chills
• Hypochondriac pain
• Irregular menstruation
• Prolapse of uterus
• Pharmacology
• Respiratory infection.
• Cough due to different lung diseases
• Viral Hepatitis
• Hypercholesterolemia
• Side Effects
• Excessive intake would lead to sleepiness, poor
  appetite, and abdominal distention.
• Injection may lead to allergic reaction.

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• Interactions
• Interactions with Drugs
• (1)Bupleurum may increase the risk of bleeding
  when taken with drugs that increase the risk of
  
• bleeding. Some examples include
  aspirin, anticoagulants ("blood thinners") such
  as warfarin(Coumadin) or heparin, anti-platelet
  drugs such as clopidogrel (Plavix), and
  non-steroidal, anti-inflammatory drugs such as
  ibuprofen (Motrin, Advil) or naproxen
  (Naprosyn, Aleve).
• (2)Bupleurum may stimulate the adrenals and may
  decrease the effects of antihypertensives(drugs
  for high blood pressure). Patients taking blood
  pressure medications, including beta-blockers or
  ACE inhibitors, should use cautiously.
• (3)Although not well-studied in humans, bupleurum
  may reduce cholesterol levels. Caution is advised
  in patients taking cholesterol-lowering agents.
• (4))Bupleurum may increase the amount of
  drowsiness caused by some drugs. Examples include
  benzodiazepines such as lorazepam (Ativan) or
  diazepam (Valium), barbiturates such as
  phenobarbital, narcotics such as codeine, some
  antidepressants, and alcohol.

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• 
  Ge Gen (Kudzu)
• Kudzu originated in China and was brought to the
  United States from Japan in the late 1800s. It is
  distributed throughout much of the eastern United
  States and is most common in the southern part of
  the continent.
• Kudzu has traditionally been used in China to
  treat alcoholism, diabetes (high blood sugar),
  gastroenteritis (inflamed stomach or intestine),
  and deafness.
• Evidence suggests kudzu may improve signs and
  symptoms of unstable angina (chest pain), improve
  insulin resistance, and have a positive effect on
  cognitive function in postmenopausal women.
  However, most studies have suffered from
  methodological weaknesses and small sample sizes.
• Chinese healers have used kudzu to treat high
  blood pressure and chest pain and to minimize
  alcohol cravings. Research indicates that
  puerarin (a constituent of kudzu) may increase
  blood flow to the heart and brain which helps
  explain certain traditional uses.

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•    Ge Gen (Kudzu, pueraria)
• Main Components
• Daidzin
• Daidzein
• Puerarin
• Effects HTCM
• Reducing fever.
• Effects on circulatory system
• (1)   Puerarin can reduce blood pressure
• (2)   Promote the circulation of the brain
• (3)   Dilate the coronary vessels. It can relax
  the spasm of coronary vessels. Good for coronary
  heart diseases.
• (4)   Promote heart function.

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• Relax the smooth muscles of the intestines
• Other actions
• (1)   It can reduce the function of platelets
• (2)   It can lower blood sugar
• Indications
• Hypertension
• Coronary Heart Diseases
• Migraines
• Side Effects

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• 1. Side Effects and Warnings
• Currently, there are no side effects reported of
  kudzu treatment when taken by mouth. Intravenous
  puerarin has caused intravascular hemolysis
  (destruction of red blood cells). Intraperitoneal
  administration of puerarin or crude extracts of
  Pueraria lobata caused hypothermia (low body
  temperature).
• In theory, intraperitoneal administration of
  puerarin or crude extracts of Pueraria lobata may
  cause hypothermia. Kudzu root may also cause
  weight loss, although this has not been well
  studied in humans.
• 2. Interaction
• Antidiabetics
• Anticoagulant antiplatelet drug
• 3. Pregnancy Breastfeeding
• Kudzu is not recommended in pregnant or
  breastfeeding women due to a lack of available
  scientific evidence.

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• Chapter 3 Herbs that clear Heat Syndrome
•  
• Properties of herbs that clear heat syndrome
•  
• Anti-microbial.
• (1)   Anti-bacterial and also eliminate bacterial
  toxin (e.g. gram-positive Staphylococcus and
  gram-negative Colibacillus)
• (2)   Anti-viral (e.g. Influenza virus)
• Anti-toxin
• (1)   Decrease the endotoxin of gram-negative
  bacteria.
• (2)   Anti-bacterial exotoxin

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• Anti-pyretic (abating fever)
• The action is related to the anti-microbial and
  anti-toxin properties of the herbs.
• Effects on immune function
• Some of the herbs increase the WBC and their
  phagocytic function. (e.g. Huang Lian, Huangqin).
  Some of them restrain the phagocytic function.
• Anti-inflammation
• Anti-cancer
• Expelling free radicals the free radicals are
  related to age and cancer.
•  Examples of herbs that clear heat syndrome

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• Huang Lian (Coptis root)
• Huang Lian can do no right, Ren Shen can do no
  wrong
• Main Components
• Berberine
• Coptisine
• Worenine
• Palmatine
• Effects and HTCM
• Anti-microbes
• Anti-toxin
• Anti-pyretic (abate fever)
• Effects on immune function

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• 5. Effects on cardiovascular system
• (1)   Reduce ventricular arrhythmia, ventricular
  fibrillation and atrial flutter.
• (2)   Promote cardiac contractility.
• (3)   Reduce heart rate
• (4)   Lower blood pressure (especially good for
  diastolic pressure)
• Prevent platelet adhesion
• Lower blood sugar, anti-cancer (for leukemia)

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• Indications
• Hypertension
• Supra-ventricular arrhythmia
• Dysentery
• Acute Enteritis
• Cholecystitis
• Respiratory tract infection
• Diabetes
• Side Effects
• Little
• A few suffer from allergic reactions (drug
  rashes)
• Gastrointestinal effects fullness, nausea,
  vomiting

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Berberine

• Huang lian root contain berberine 5-7
• Berberine and its relative derivatives show
  antidiarrhtic , antimicrobial, anticancer,
  antiinflammatory and antiarrhythmic et al

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Berberine

• Berberine is a bitter-tasting, yellow, plant
  alkaloid.
• It is present in the roots, and stem bark of
  various plants
• Berberine has also been used historically as a
  dye, due to its yellow color.

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Berberine Activity

• Antimicrobial
• Cardiovascular effects
• Anti-inflammatory effect
• others

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Antimicrobial Effects

• Bacterial Diarrhea
• Intestinal Parasites
• Ocular infections
• Et al

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Bacterial Diarrhea

• Direct antibacterial effects
• Inhibiting the intestinal secreatory response
  cause by V. cholerae, and E. coli
• Also block the adherence of bacterial to
  erythrocytes and epithelial cells
• Clinical studies showed that a single dose of
  berberine sulfate 200-400mg orally significantly
  reduced liquid diarrhea stool compare to control
  without side effects (Rabbani et al 1987 1996)

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Dosage and toxicity

• The LD 50 of berberin in mice 25mg/kg iv. while
  no gross toxic effects in dog at 45 mg/kg
• High doses may result in lowered BP, dyspnea,
  flu-like symptoms, GI discomfort and cardiac
  damage
• The therapeutic dose of berberine as oral
  supplement is typically 200 mg two or three times
  daily

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pharmacokinetics

• Sulfate-conjugated metabolites of berberine were
  identified after oral administration at 0.9 g per
  day, 3 days, in healthy volunteers' urine.
• Little berberine was recovered in urine compared
  with its metabolites (Pan et al., 2002 ).
• Berberine seems to be extensively metabolized in
  the body.
• there is little information available on
  pharmacokinetics following administration. .

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Huang qin

• Scutellaria baicalensis Georgi
• Has antioxidant, antiviral, antibacterial,
  antiinflammatory, antiallergic, and sedative
  properties.
• Major components are flavonoids, such as
  baicalin, baicalein, wogonin et al, dominated by
  baicalin, which makes up 12-17 of the root

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Baicalein

• Baicalein, one of the major flavonoids contained
  in the dried roots, possesses a multitude of
  pharmacological activities.

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Baicalein and dosage

• In China, baicalin is prepared in injection form
  for rapid action.
• The dosage is 60-120 mg of baicalin
  intramuscularly, 1-2 times per day or a daily IV
  drip containing 500-1200 mg may be utilized for
  more severe diseases.
• Orally, Huangqin is given in decoction, with
  dosages of about 6-12 grams per day, yielding
  baicalin in amounts of 1-2 grams.
• Baicalein tablets, and highly purified baicalein
  extracts in powder form (with 95 flavonoid
  content) are used at doses of 1-2 grams per day.
  These treatments are usually for acute syndromes
  lower doses of baicalin in complex formulas would
  be utilized for prolonged therapy.

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Pharmacokinetics

• Baicalin orally, slow absorbed, take 7-16 hrs to
  the peak concentration
• im, quick absorb, takes 0.4 hrs to peak
  concentration, half time about 0.6 hrs
• Kidney excretion

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Baicalin activity

• Inhibition of infections (especially respiratory
  tract viral infections).
• Anti-inflammatory (e.g., for asthma or atopic
  dermatitis)
• Inhibition of cancer cell proliferation
• Protecting bone marrow and promoting hemopoiesis
  during cancer therapies and protecting the
  intestines from adverse chemotherapy effects
• Blood pressure lowering
• Sedative,
• Bile-secreting,
• Neuroprotective and hepatoprotective

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Inhibition of infections

• Antibacterial and antiviral agents. They are
  effective against staphylococci, cholera,
  dysentery, pneumococci and influenza virus.
• especially respiratory tract viral infections
• anti hepatitis B virus. Both Huangqin and
  isolated baicalin are widely used in China for
  treatment of viral hepatitis and are believed to
  have potent protective action against liver
  fibrosis caused by viral activity.

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Formula

• Shuanghuanglian (SHL for short) is a modern
  formula
• extracts of three herbs lonicera (shuanghua,
  often called jinyinhua), scute (huangqin), and
  forsythia (lianqiao). (211)
• treatment of respiratory tract infections, cases
  of viral myocarditis et al.

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Anti-inflammatory

• Cyclooxygenase (COX) and 5-lipoxygenase (5-LOX)
  inhibition in a dose-dependent manner
• Prostaglandin E2 generation was inhibited
• for asthma or atopic dermatitis

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Huang qin

• anti - histamine effect huang qin possesses
  antihistamine effect. It can inhibit edema of
  rats model.
• anti allergenic effect alcohol extract of huang
  qin inhibits acute asthma attack and allergenic
  eczema.
• Baicalein inhibits permeability of capillaries
  and anti acetylcholine and anti anaphylaxis
  effects.

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Anti-tumor

• Inhibition of cancer cell proliferation
• Induction of apoptosis by baicalin was
  accompanied with the marginal generation of
  intracellular reactive oxygen species (ROS), the
  increase of the cytochrome c, and the disruption
  of mitochondrial transmembrane potential prior to
  the activation of caspase-3.
• On the other hand, baicalin showed little toxic
  effect on peripheral blood mononuclear cells from
  healthy volunteers.
• These results indicate that baicalin acts as a
  prooxidant and induces apoptosis via
  mitochondrial pathway.

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Antioxidants

• Antioxidants play a key role in cardiovascular
  disease, cancer, cataract formation, the aging
  process, inflammatory diseases, and a whole
  variety of neurological disorders.

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Inflammation and cancer

• Chronic infection and inflammation contribute to
  about 25 of all cancer cases worldwide

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Anti-tumor

• Flavones (chrysin, baicalein, and galangin),
  flavanones (naringenin) and isoflavones
  (genistein, biochanin A) inhibit the activity of
  aromatase (CYP19), thus decreasing estrogen
  biosynthesis and producing antiestrogenic
  effects, important in breast and prostate
  cancers.

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Others

• Protecting bone marrow and promoting hemopoiesis
  during cancer therapies and protecting the
  intestines from adverse chemotherapy effects

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lowers blood pressure

• Plant-derived baicalein and its analogs are used
  to treat arteriosclerosis and hypertension.
• In vivo hypotensive effect may be partly
  attributed to its inhibition of biosynthesis and
  release of arachidonic acid-derived
  vasoconstrictor products.
• Baicalein may reduce vasoconstricting sensitivity
  to receptor-dependent agonists such as
  noradrenaline, phenylephrine.
• inhibition of the endothelial nitric
  oxide-dependent mechanism.

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anti-thrombotic

• Baicalein inhibits thrombin-induced production of
  plasminogen activator inhibitor-1, and
  interleukin-1beta- and tumor necrosis
  factor-alpha-induced adhesion molecule expression
  in cultured human umbilical vein endothelial
  cells.

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Anti-ischemia-reperfusion injury in
cardiomyocytes..

• The free radical scavenging capacity
• When flavonoids were administered during
  ischemia/reperfusion, baicalein significantly
  reduced cell death.

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Anti-atherosclerosis

• Atherosclerosis is a multiple factors disease, in
  which the main roles play oxidant stress,
  endothelium dysfunction and disorders of
  hemostasis
• Hangqin in the nearest future could be used in
  the primary and secondary prevention of
  atherosclerosis
• Mechanism anti-oxidant, increase HDL and reduces
  TG et al.

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• Qing Hao(http//www.who.int/mediacentre/f
  actsheets/fs094/en/index.html)
• II. WHO RECOMMENDATIONS ON MALARIA TREATMENT
• antimalarial medicines, WHO recommends that all
  countries experiencing resistance to conventional
  monotherapies, such as chloroquine, amodiaquine
  or sulfadoxine yrimethamine, should use
  combination therapies, preferably those
  containing artemisinin derivatives (ACTs
  artemisinin-based combination therapies) for
  falciparum malaria (3, 4).
• Forms of artemisinin, developed in China from the
  wormwood plant, have become the leading treatment
  but only when used together with older
  medications. This artemisinin combination
  therapy, known as ACT is 95 percent effective in
  curing malaria.

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• 1. Antimalarial The mechanism is associated with
  the blocked utilization of host erythrocyte
  protein by the plasmodium, causing starvation and
  death.
• 2. Antibiotic It can inhibit Staphylococcus
  aureus, Neisserria catarrhalis.
• 3. Antihypertensive It can decrease ht rate,
  inhibite contraction of the cardic muscle.
• 4. Antipyretic
• 5. Cholagogic it can increase the production
  excretion of bile in rates.

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• WHO currently recommends the following
  combination therapies (in alphabetical order)
• artemether/lumefantrine
• artesunate plus amodiaquine (In areas where the
  cure rate of amodiaquine monotherapy is greater
  than 80)
• artesunate plus mefloquine (Insufficient safety
  data to recommend its use in Africa)
• artesunate plus sulfadoxine/pyrimethamine (In
  areas where the cure rate of sulfadoxine/pyrimetha
  mine is greater than 80)
• Note Amodiaquine plus sulfadoxinepyrimethamine
  may be considered as an interim option where ACTs
  cannot be made available, provided that efficacy
  of both is high.

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• Zhi Mu (Radix Anemarrhence)
• Main Components
• Timosaponin, mangiferin, sarssapogenin.
• Effects and HTCM
• Anti-microbes It has effect against
  Staphylococcus aureus, aand ß-hemolytic
  strepcholerace, Salmonella typhi, E.coli,
  Bacillus subtilis.
• Antidiabetic
• 3. Anti-pyretic (abate fever) It has a slow
  onset but pronged duration.
• Interaction
• Antidiabetics

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• Coptis Detoxicating Decoction (Huang Lian Jie Du
  Tang)
• Ingredients
• Huang Lian (Coptis root) 9g
• Huang Qin (Scutellaria root) 6g
• Huang Bai (Phellodendron bark)6g
• Zhi Zi (Capejasmine fruit) 6g

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• Effects HTCM Purging fire and expelling
  toxin.
• Used for fire toxin obstructing the three Jiaos.
• Anti-microbes and Anti-toxin(anti-bacillus
  dysenteriae)
• Anti-pyretic and sedating
• Effects on immune function
• Lower blood pressure
• Without Huang Lian in the formula , the blood
  pressure lowering action is decreased.
• Without Huang Qin and Zhi Zi in the formula, the
  blood pressure lowering action is increased.
• Promotes cerebral circulation. It can treat
  senile dementia and dementia due to cerebral
  ischemia.
• Anti-peptic ulcer. It can control the activity of
  hydrogen ions in digestion.

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• Indications
• Septicemia, Pyotoxinemia
• Tonsillitis
• Hypertension
• Diseases of cerebral vessels
• Sequelae of wind stroke
• Alzeheimers disease
• Herpes Zoster
• Side Effects
•  

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• Chapter 4 Herbs that purge
•  Properties of herbs that purge
• 1. Purging action
• (1)   Stimulate the movement of the intestine (Da
  Huang)
• (2)   Increase the water content of the intestine
  (Mang Xiao)
• (3)   Moisten the stool (Huo Ma Ren)
• Induce urination
• Anti-microbes, anti-toxin Anti-amoebic dysentery
• Anti-inflammation
• Da Huang accomplished this by decreasing the
  prostaglandin (PG)

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• Anti-cancer
• Da Huang can kill breast cancer cells by means of
  restraining their protein synthesis
•  
• Examples of herbs that purge

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• Da Huang (Rhubarb)
• Main Components
• Anthraquinone (chief component for purging)
• Glycoside
• Rhein
• Chrysophanol
• Emodin
• Acatechin
• 7. Gallic acid

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• Effects HTCM
• Purge heat to relieve constipation and clear
  gastrointestinal tract as well as invigorating
  blood to remove stasis.
• Effects on digestive system
• (1)   Purging actions stimulate intestinal
  movement. However, it can cause constipation if
  it is decocted for a longer time because of
  tannic acid
• (2)   Protect liver and cholagogize (benefit the
  gall bladder)
•     a. It can help the gall bladder contract
  promoting bile secretion
•     b. It can lower serum cholesterol level
• c.It can prolong the life of liver cells and
  promote regeneration of liver cells

69

•  (1)   Stimulate pancreatic secretions and
  restrain the activity of pancreatic juices
• TCM believes Da Huang is cold and bitter and will
  injure the stomach.
• (2)   Anti-peptic ulcer
• a. It can control the activity of hydrogen ion in
  digestion
• b. It can prevent stress to ulcer by means of
  promoting the PGE2
• 2. Effect on blood
• (1)   Stop bleeding
• The a-catechin and gallic acid can increase the
  adherence of platelets. They can increase the
  contraction of blood vessels
• (2) Reduce blood stasis

70

•    
• 3.Promote the renal function
• (1)   It can lower the level of BUN and
  Cholesterol and triglycerides.
• (2)   It has a remarkable suppressive effect on
  the growth of both the renal tubules and the
  mesangial cells in vitro by suppressing the
  production of TNF and IL-1.

71

•    
• 4. Anti-infection
• (1)   The rhein, chrysophanol, emodin can
  suppress bacteria
• and virus
• (2)   Anti-pyretic and sedating actions
• (3)   Effects on immune function
• 5.Anti-cancer
• Rhein, chrysophanol, emodin, a-catechin and
  gallic
• acid can suppress the RNA and DNA synthesis of
• cancer cells.

72

• Indications
• Constipation
• Bleeding Ulcer hematemesis
• Dysentery and Acute Enteritis
• Acute Abdominal inflammation (Pancreatitis,
  Peritonitis)
• Renal failure
• 6. Hyperlipidemia

73

• Side Effects
• It causes pathologic changes in liver and thyroid
  with hypertrophy of tissue cells.
• Common adverse effects nausea, vomiting,
  diarrhea, and abdominal pain.
• Drug interaction prolonged use of Da Huang may
  cause loss of potassium, leading to increased
  toxicity of cardiac glycosides, such as digoxin.

74

• Da Cheng Qi Decoction (Major Order the Qi
  Decoction)
• Ingredients
• Da Huang (Rhubarb) 12g
• Mang Xiao (Mirabilite) 9g
• Hou Po (Magnolia) 12g
• Zhi Shi (Unripened bitter orange) 9g

75

• Used for
• Yang Ming fu-organ disorder with dry stool in the
  intestines
• Effects HTCM
• Purging actions
• Effects on intestinal obstruction. It can promote
  the circulation of vessels of the intestines,
  decrease blood deficiency in the intestines, and
  help the intestines to regain function after
  surgery.
• Anti-bacterial. (both gram-positive and
  gram-negative bacteria)
• Indications
• Side Effects

76

• Chapter 5 Herbs that expel dampness
• 1. Gastrointestinal To increase peristalsis of
  the intestines and production of gastric acid.
• 2. Antibiotic Huo Xiang, Cang Zhu, Hou Po, Sha
  Ren have effects against Viruses and bacteria.
• 3. Antiulcer

77

• Medicinal Uses
• Disclaimer Antibacterial Carminative
  Expectorant Homeopathy Stimulant.
• The fruit is antibacterial, carminative,
  diuretic, odontalgic, stimulant, and stomachic4,
  21, 61, 176, 240. It is taken internally in the
  treatment of abdominal pain, digestive
  disturbances and complaints such as lumbago176,
  238. It is often included in remedies for
  digestive disturbances and cough mixtures, in
  part at least for its pleasant aniseed
  flavour238. An effective remedy for various
  digestive upsets, including colic, it can be
  safely given to children254. The fruit is also
  often chewed in small quantities after meals in
  order to promote digestion and to sweeten the
  breath4, 238. The fruit has an antibacterial
  affect similar to penicillin176. The fruit is
  harvested unripe when used for chewing, the ripe
  fruits being used to extract essential oil and
  are dried for use in decoctions and powders238.
  A homeopathic remedy is prepared from the
  seed4.

78

•  Nat Cell Biol. 1999May1(1)60
• Indirubin(Dian Yu Hong), the active constituent
  of a Chinese antileukaemia medicine, inhibits
  cyclin-dependent kinases.Hoessel R, Leclerc S,
  Endicott JA, Nobel ME, Lawrie A, Tunnah P, Leost
  M, Damiens E, Marie D, Marko D, Niederberger E,
  Tang W, Eisenbrand G, Meijer L.Department of
  Chemistry, University of Kaiserslautern,
  Germany.Indirubin is the active ingredient of
  Danggui Longhui Wan, a mixture of plants that is
  used in traditional Chinese medicine to treat
  chronic diseases. Here we identify indirubin and
  its analogues as potent inhibitors of
  cyclin-dependent kinases (CDKs). The crystal
  structure of CDK2 in complex with indirubin
  derivatives shows that indirubin interacts with
  the kinase's ATP-binding site through van der
  Waals interactions and three hydrogen bonds.
  Indirubin-3'-monoxime inhibits the proliferation
  of a large range of cells, mainly through
  arresting the cells in the G2/M phase of the cell
  cycle. These results have implications for
  therapeutic optimization of indigoids.

79

• Example of herbs that expel dampness
•  
• Huo Xiang Zheng Qi San (Agastache powder to
  rectify the qi)
• Ingredients
• Hou Po (Magnolia Officinalis)
• Components essential oil and some alkaloids
• Huo Xiang (Pogostemon Cablin)
• Components essential oil, patchouli alcohol,
  and pogostone

80

• Effects HTCM
• Regulate the function of the stomach and
  intestines
• (1)   Relax intestinal spasm
• (2)   Low dosage can stimulate movement of
  stomach and intestines
• Promote the digestive function. It can help the
  intestines absorb sugar and water
• Analgesia. It can stop the pain caused by heat in
  rats.
• Increase the immune function. It can increase the
  lymphocytes in the blood and help injured
  intestines to recover.
• Anti-bacterial. It can suppress Staphylococcus
  aureus, Typhoid, Bacillus, Bacillus dysenteriae.

81

• Indications
• Stomach flu
• Acute gastroenteriris, acute colitis
• Side Effects
• Huo Xiang Zheng Qi Shui can cause drug rash. When
  herb intake is discontinued, the rash will
  disappear.

82
Dan Shen
83
Dan shen

• The dried root of Salvia miltiorrhiza
• A commonly used traditional Chinese medicine to
  improve circulation and improve blood flow
• Used for treating cardiovascular diseases such as
  coronary heart disease, hyperlipidemia and
  cerebrovascular disease

84
Chemical constituents

• Lipophilic and hydrophilic compounds
• LipophilicTanshinone analogues (tanshinone IIA
  et al.)
• Hydrophilic Salvianolic acids, danshensu et al.

85
Pharmacokinetics

• Major components absorbed rapidly after oral
  administration
• Metabolized extensively by liver
• Excreted from stool and urine,
• Some components have low short half life, low
  bioavailability, because of extensive metabolism

86
Danshensu

• Dilates coronary arteries,
• Inhibit platelet aggregation
• Improve microcirculation
• Protect the myocardium from reperfusion injury

87
Danshensu

• The mechanism
• - prevent intracellular calcium increase
• - remove oxygen free radicals
• - Inhibit myocardial cell apoptosis
• - protect the endothelial cells against
  homocysteinemia (risk factor for cardiovascular
  diseases and atherosclerosis)

88
Salvianolic acid B

• Protect the brain from ischemia-reperfusion
  injury
• Inhibit platelet aggregation
• Prevent low density lipoprotein (LDL), uptake by
  cells
• Stimulate nitric oxide production by endothelial
  cells
• Remove free radicals

89
Tanshinone IIA

• Free radical scavenger property
• Also inhibition of angiotensin II activity,
  attenuating cardiac cell hypertrophy

90
Angina

• The commonest herb used to treat angina
• Improve microcirculation
• Induce coronary vaso-dilation
• Inhibit platelet adhesion and aggregation
• Suppressing thromboxane formation

91
Angina

• Sublingual nitroglycerin is the gold standard for
  acute angina attacks
• Provide an exogenous source of vasodilator-
  nitric oxide
• Induce coronary and peripheral vasodilation
• Prolonged nitrate therapy inhibit endothelium
  nitric oxide synthase cause nitrate tolerance

92
Nitrate therapy

• Vasodilatory effects
• Reduce oxygen demand

93
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94
Angina

• Several research suggests that danshen is more
  suitable than isosorbide dinitrate in long-term
  treatment for angina
• And suggests danshen is more effective than
  nitrates in the improvement of symptoms and ECG
  tests

95
Angina

• Plus, increased platelet aggregation occurs in
  patients with angina, which can reduce the effect
  of nitrates therapeutic
• The development of tolerance to nitrate therapy

96
More therapeutic activities

• Coronary artery spasm
• Myocardial infarction
• - opening and formation of coronary collateral
  circulation
• - additionally, has sedative, antioxidant,
  antiplatelet, and improve microcirculation
  effects

97
Hyperlipidemia

• Reduce total cholesterol and LDL, which are risk
  factors for coronary atherosclerosis
• Protect endothelial cells from homocysteine-induce
  d injury

98
Hypertension

• Inhibit angiotensin converting enzyme and
  directly inhibit angiotensin II action
• Reduce blood viscosity
• As a complementary therapy for pregnancy induced
  hypertension
• Reduce incidence of arrhythmia

99
Peripheral vascular disease

• Dilate peripheral vascular
• - reduce smooth muscle contraction
• - stimulate vascular dilating molecular
  production
• Pulmonary vascular disease, protection against
  pulmonary thromboembolism
• Improve vascular disease of diabetes patience

100
Renal disease

• Renoprotective effects
• Help for recovery of renal function in the early
  stage of renal transplantation
• Reduce blood viscosity, patelet aggregation and
  free radicals et al,

101
Side effects

• No major side effects
• May hypotension, dizziness, drowsiness, abdominal
  discomfort, decrease appetite and itching..
• LD50 of water soluble extract was almost 4000
  times higher in mice than the clinical human oral
  dosage

102
Dan shen

• Numerous forms of Danshen are available in China
• Fufang Danshen (with Panax notoginseng,
  Cinnamomum camphora)
• Has been registered as a drug in several
  countries
• And was the first TCM product approved by FDA for
  phase II and phase III clinical trials

103
Drug interaction

• Warfarin
• Potentiate the anticoagulant action- bleeding
• Increase the half life (CYP 450)
• Avoid patient taking warfarin

104
Drug interaction

• Most drugs are bound to serum proteins to a
  various degree.
• Only unbound or free drug is pharmacologically
  active.
• under certain conditions, the equilibrium is
  disturbed and the measured free drug
  concentration can be significantly, especially
  for strongly protein-bound drugs.
• In such case a patient may experience drug
  toxicity even if the total drug concentration is
  within the therapeutic range.

105
Drug interaction

• Danshen (50-70) strongly bind to protein
• Albumin as the major serum protein that binds
  Danshen.
• Salicylate, which is also strongly bound to
  albumin, is a widely used over-the-counter
  medicine in the U.S.
• Digoxin

106
More

• Reduces alcohol intake in alcohol- preferring
  rats
• Hamper alcohol absorption from GI track without
  affect the severity of alcohol withdrawal
  syndrome in rats

107
Sanqi (Panax notoginseng)
108
Sanqi

• The root of Panax Notoginseng
• It is the largest ingredient in ???? (Yunnan Bai
  Yao), a famous hemostatic herbal remedy
• Sweet and slightly bitter in taste, and nontoxic.
• The dose in decoction for clinical use is 5-10 g.
  It can be ground to powder for swallowing
  directly or taking mixed with water the dose in
  that case is usually is 1-3 grams.

109
Sanqi

• Hemostatic effect
• Cardiovascular effect
• Protect the liver
• Anti-inflammatory effects
• Anti-carcinogenic effects on some forms of
  cancer.

110
Sanqi

• Contains many chemical constituents.
• Saponins derivatives (PNS), which is a mixture of
  more than 20 types of saponins, four or five of
  them are considered as the principle active ones
• Notoginenoside R1, ginsenoside Rg1, Rd, Re and
  Rb1 (75-80 total PNS)
• Flavonoids et al.

111
Pharmacokinetics

• Oral administration, most Saponins derivatives
  (powder) tested in rats, reached peak
  concentration in plasma rapidly within about 0.75
  h - hint their absorption were quick.
• Maximum concentration in rat plasma were low
• indicated that it may be poorly absorbed and / or
  extensive metabolized (intestinal microflora,
  liver) .

112
Pharmacokinetics

• Half time was changed from 1 to 20 hrs in rat
  plasma after oral administration of the
  constituents
• Iv in rats, most constituents were cleared
  quickly except a couple of PNS
• the pharmacokinetic profile diversities of these
  constituents are probably one of the mechanisms
  of the multiple pharmacology activities

113
San-qi

• Many preparation were used in clinic in China
  (tablet, drop pill and injection)
• Xuesaitong injection is consisted with only PNS
• Very difficult to evaluate the pharmacokinetic
  profile
• Pharmacokinetics parameters are different from
  individual compounds

114
San-qi Hemostatic effect

• San-qi and a saponin (PNS) extract provide
  hemostatic effects. External application reduces
  bleeding time
• The effect lost significantly after heating

115
Sanqi

• Combination with Salvia miltiorrhiza (Danshen)
  and Ligusticum (Chuanxiong) efficaciously reduces
  lipoperoxidative damage to tissues

116
Thrombogenicity effects

• PNS reduces platelet activation, adhesion and
  aggregation
• Prevent thrombosis and improve microcirculation
  in patients with blood hyperviscosicity syndrome

117
Thrombogenicity effects

• PNS iv or oral 200 mg/kg need 20 days to appear
• hint a slow effect compare to hemostatic

118
Fibrinolytic effects

• Sanqi (the extract as notoginsenoside R1)
  increased the fibrnolytic potential in in vivo
  lab test, which may be beneficial to
  cardiovascular disease

119
Cardiovascular effects

• Dilate the coronary artery
• Increase coronary blood flow, providing more
  blood to the heart muscle
• Improves micro-circulation in and around damaged
  heart tissue
• Reduces cardiac load, lowers arterial pressure

120
Cardiovascular

• Decrease the size of myocardial infarction
• Anti-arrhythmia
• PNS increases PGI2 and reduces thromboxane A2 in
  platelets correct the unbalance between the two
  prostaglandins

121
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122
Anti-atherosclerotic effect

• It helps lower cholesterol and triglycerides, to
  prevent the progression of atherosclerotic lesion
  

123
Effects on brain

• Protect ischaemic brain damage
• Decrease brain edema, infarct size and neuron
  damage
• Inhibit uptake calcium by neuron cells isolated
  from rats
• Protect cultured rat cortical neuron from
  glutamate neurotoxicity

124
Ischemic cascade

• Lack of oxygen causes the neuron's normal process
  for making ATP for energy to fail.
• The cell switches to anaerobic metabolism,
  producing lactic acid.
• ATP-reliant ion transport pumps fail, causing the
  cell to become depolarized, allowing ions,
  including calcium (Ca), to flow into the cell.
• The ion pumps can no longer transport calcium out
  of the cell, and intracellular calcium levels get
  too high.
• The presence of calcium triggers the release of
  the excitatory amino acid neurotransmitter
  glutamate.
• Glutamate stimulates AMPA receptors and
  Ca-permeable NMDA receptors, which open to
  allow more calcium into cells.
• Excess calcium entry overexcites cells and causes
  the generation of harmful chemicals like free
  radicals, reactive oxygen species and
  calcium-dependent enzymes such as calpain,
  endonucleases, ATPases, and phospholipases in a
  process called excitotoxicity.56 Calcium can
  also cause the release of more glutamate.
• As the cell's membrane is broken down by
  phospholipases, it becomes more permeable, and
  more ions and harmful chemicals flow into the
  cell.
• Mitochondria break down, releasing toxins and
  apoptotic factors into the cell.
• The caspase-dependent apoptosis cascade is
  initiated, causing cells to "commit suicide."
• If the cell dies through necrosis, it releases
  glutamate and toxic chemicals into the
  environment around it. Toxins poison nearby
  neurons, and glutamate can overexcite them.
• If and when the brain is reperfused, a number of
  factors lead to reperfusion injury.
• An inflammatory response is mounted, and
  phagocytic cells engulf damaged but still viable
  tissue.
• Harmful chemicals damage the blood brain barrier.
  
• Cerebral edema (swelling of the brain) occurs due
  to leakage of large molecules like albumins from
  blood vessels through the damaged blood brain
  barrier. These large molecules pull water into
  the brain tissue after them by osmosis. This
  "vasogenic edema" causes compression of and
  damage to brain tissue.
• The fact that the ischemic cascade involves a
  number of steps has led doctors to suspect that
  neuroprotectants such as calcium channel blockers
  or glutamate antagonists could be produced to
  interrupt the cascade at a single one of the
  steps, blocking the downstream effects. Though
  initial trials for such neuroprotective drugs led
  many to be hopeful, until recently, human
  clinical trials with neuroprotectants such as
  NMDA receptor antagonists were unsuccessful.

125
Basic mechanism of excitotoxicity of stroke

• It is widely believed that calcium entry into
  neurons significantly contributes to ischemia
  related toxicity
• remove Ca in experimental setting greatly
  reduced hypoxic damage to neuron

126
Therapeutic strategy

• Restore blood supply
• Minimizing Ca influx into cells
• Reducing free radical damage
• Promoting neural recovery

127
Tumor Radio-sensitivity

• Taiwanese scientists studied the sensitization
  effect of Panax notoginseng extract and purified
  Saponin (Rb1) on the radiation response of an
  experimental tumor (KHT sarcoma) in comparison
  with its effects on a normal tissue (bone marrow)
  in mice

128
Tumor Radiosensitivity

• Panax notoginseng extract at a concentration of
  0.1-100 mg/kg produced an increase in tumor
  radiosensitivity.
• Rb1 at a concentration 0.001 to 1 mg/kg produced
  an increase in tumor radiosensitivity, with
  maximum effect at 1 mg/kg.
• The effect was maximal at 10 mg/kg and at 30
  minutes after injection.
• Higher doses of notoginseng (not Rb1) were toxic
  to the bone marrow stem cells
• Further purified or synthetic versions are useful
  in cancer therapy.

129
Toxicity

• Low
• Esophagitis from consuming tablets (drink enough
  water) may occur
• Allergic reactions including dermatitis, shock,
  purpura, blisters, or other idiosyncratic
  reactions

130

• Chapter 6 Herbs that tonify
•  
• Properties of herbs that tonify
•  
• Effects on the immune function
• (1)   It can increase the WBC and prevent the
  decrease of WBC caused by chemotherapy
• (2)   It can promote the phagocytic function of
  phagocytes
• (3)   It can build the function of Th cells
• (4)   It can regulate or help body produce IgG,
  IgA, and SIgA

131

• 2. Effects on the nervous system
• (1)   Regulate the function of cerebral cortex (
  Ginseng, Huangqi)
• (2)   Excite the nervous function (Ginseng, Lu
  Rong)
• (3)   Promote the circulation of the brain (Dang
  Gui)
• (4)   Components of the herbs are rich in
  proteins, vitamins, and trace elements which can
  nourish the cerebral cells, promote the
  development of the brain, prevent cerebral
  senility.

132

• 3. Promote endocrine functions
• There are degenerations or atrophies of endocrine
  organs in most of the deficient syndromes.
• (1) Promote the functions of hypothalamus-pituitar
  y gland-adrenal gland.
• Ginseng, Huang qi and Wu Jia Pi can stimulate the
  hypothalamus and pituitary gland to secrete ACTH
  which in turn increases the cAMP (cyclic
  adrenosine monophosphate) of the adrenal gland
  and help it to synthesize cortical hormone.
• (2) Excite the thalamus-pituitary gland-sexual
  gland
• Yin Yang Huo, Gou Qi Zi can excite them and
  promote the secretion of sexual hormone.
• (3)   Excite the thalamus-pituitary gland-thyroid
  gland
• Some formulas that tonify yang (You Gui Wan) can
  stimulate thyroid functions.

133

• 4. Effect on the cardiovascular system
• (1)   Ren Shen, Huang Qi, Mai Men Dong, Sheng Mai
  San, Shen Fu Tang can promote function of the
  heart.
• (2)   Dang Gui, Yin Yang Huo, Mai Men Dong can
  dilate coronary artery, promote the circulation
  of the coronary artery, and treat myocardial
  ischemia.
• (3)   Dang Gui, shu di Huang, Liu Wei Di Huang
  Wan can lower blood pressure.
• (4)   Si Jun Zi Tang, Sheng Mai San, Shen Fu Tong
  increase the blood pressure.
• 5. Promote the hematopoietic function
• Dang Shen, Dang Gui et al. can increase RBC by
  stimulating the hematopoietic function of bone
  marrow.

134

• 6. Effects on the digestive system
• Dang Shen, Bai Zhu, Si Jun Zi Tong relax
  intestinal spasm, and regulate intestinal
  movement , anti-peptic ulcer.
• 7.Prolong life
• (1)  Ren Shen, Huang Qi can prolong animal cells
  life.
• (2)  Yin Yang Huo can stimulate the function of
  SOD (superoxide dismutase)
•  
• Examples of herbs that tonify

135

• Ren Shen (Ginseng)
• Huang lian doesnt get credit for curing
  diseases, and Ren Shen doesnt get punished even
  if it kills the patient.
• Main Components
• Volatile oil (0.05)
• saponins, known as panaxosides or ginsenosides
• antioxidants
• peptides
• polysaccharides
• fatty acids

136

• Effects HTCM
• 1. Effects on central nervous system
• It has a stimulating effects in low doses, but
  an inhibiting effect in large doses. It increases
  the amounts of dopamine and norrepinephrine in
  the brain stem.
• 2. cognitive improve memory and learning
  ability.
• 3.Endocrinological it stimulates pituitary gland
  to increase the secretion of ACTH.
• 4. Immunostimulant
• 5 cardiovascular
• 6. Hypoglycemic
• 7. reproductive

137

• 2. Anti-cancer activity
• (1)   It can inhibit several types of cancer cell
  growth in vitro
• (2)   Mice innoculated with S-180 cancer cells
  survive for a longer time if given ginsenosides.
• (3)   Has the ability to inhibit the adhesion and
  invasion of tumor cells in the lungs primarily
  due to their antiangiogenesis activity.
• 3.Anti shock

138

• Indications
• Arrythmia for atrial fibrillation, sick sinus
  syndrome, ventricular arrhythmia.
• Angina pectoris
• Leukopenia
• Hepatitis
• Cancer
• Diabetes
• Prolonged life
• Side Effects
• It could cause eruptions, itching, headache,
  dizziness, and body temperature increase as well
  as bleeding. It is prohibited in excessive
  syndromes, and damp-heat syndromes.

139

• Huang Qi ( Astragalus Membranaceus)
• It is sweet, slightly warm. Enters Lung and
  spleen. Tonify qi and stabilze exterior, promote
  urination and reduce edema, promote the discharge
  of pus and generate the flesh.
• Main Components
• Carbohydrates of astragalus
• Glycoside
• Alkaloids
• 4. amino acids, et al.

140

• Effects HTCM
• Effects on the immune function
• (1)   It can increase the WBC and prevent the
  decrease of WBC caused by chemotherapy.
• (2)   It can promote the phagocytic function of
  phagocytes
• (3)   It can build the function of helper T
  lymphocytes (Th cells)
• (4)   IT can regularte or help body produce IgG,
  IgA, SIgA
• (5)   It can stimulate the lymphocyte activating
  factor

141

•    
• 2. Prolong life
• Huang Qi can prolong the animal cells life.
• (1)   It can stimulate the function of SOD
  (superoxide dismutase)
• (2)   It can decrease free radicals
• (3)   It can increase catecholamine (CA), it
  inhibits the activity of MAO-B
• 3.Effects on the cardiovascular system
• (1)   It can promote function of the heart,
  especially heart failure due to toxicity or
  fatigue.

142

• (2)   Dilate blood vessels
• a.      It can dilate the peripheral vessels,
  cerebral vessels, renal vessels, and coronary
  vessels as well as intestinal vessels. However,
  if the dosage of Huang Qi is too high, the renal
  vessels will be contracted due to a decrease of
  blood pressure
• b.      It can promote the microcirculation,
  strengthen the defensive function of micro
  vessels, and prevent permeability of micro
  vessels caused by other diseases
• (3)   It can lower the blood pressure

143

•  
• 4. Effects on the hematopoietic function
• (1)   Promote the hematopoietic function
• It can increase the RBC and WBC by stimulating
  the hematopoietic function of the bone marrow.
• (2)   Inhibit the aggregation of thrombocytes by
  means of cAMP of thrombocytes
• 5. Effects on substance metabolism
• Indications
• Side Effects
•  

144

• Question?
• General speaking, which of the following group
  herbs they are mainly rich in alkaloid, and
  glycoside which posse anti-bacteium, Viral and
  inflammation ?.
• A. sweet herbs
• B. bitter herbs
• C. sour herbs
• D. salty herbs

145

• 2. The pungent herbs have the following actions
  except
• A. relieving exterior syndrome
• B. relaxing spasm
• C. relieving pain
• D. strengthening Qi and blood
• 3. The following herbs(aristolochic acid) have
  side effects on the kidney except
• A. Mu tong
• B. Han fang ji
• C. Chai Hu
• D. Ma duo Ling

146

• 4. What kinds of side-effects does the Ma Huang
  have?
• A.lead to bleeding of eyes, increasing the
• blood pressure
• B.exciting central nervous system
• C.lead to restlessness, insomnia.
• D. All A, B, C

147

• 5. Gui Zhi (Cinnamon twig, cinnamomun ) has the
  following actions except
• A. dilating Blood-vessels to promote sweating
• B. relieving asthma
• C. Reducing fever stopping pain.
• D. Tranquilizing

148

• 1. According to the recent research of herbal
  pharmacology, Ge Gen (Kudzu, pueraria) not only
  can be used for reducing fever, relaxing the
  smooth muscle of intestine, but also for treating
  
• A. diseases of lungs
• B. diseases of kidney
• C. diseases of digestion
• D. diseases of circulation system.
• 2. General speaking, the Herbs that clear heat
  syndrome have the following actions except
• A.Anti-microrganism, Anti-toxin
• B.Effects on immunologic function
• C. Reducing edema
• D. anti-cancer

149

• 3.Huang Lian(coptis root) is mainly used for
• acute enteritis and
• A. urinary tract infection
• B. Dysentery
• C. promote platelet adhesion
• D. disorder of the bacterium in intestine
• 4. What is the main side effect of the Huang
  Lian, if oral taking.
• A.Few of them suffers from allergic reaction.
• B.reactions of gastric-intestine.
• C.reactions of the heart
• D.reactions of the respiration

150

• 5.Chai Hu(Bupleurum Root) is mainly used for
  the following diseases except
• A. infective diseases
• B. disorders of immunologic function
• C. Diseases of digestion
• D. diseases of hemapopoietic system