The Three Treasures Newsletters
Winter 2000
RADIOTHERAPY AND RADIO-SUPPORT
Radiotherapy refers to the use of ionizing radiation to treat disease:
this newsletter will focus specifically on the use of radiation
to treat cancer. Ionizing radiation deposits energy that injures
or destroys cells in the area being treated by damaging their genetic
material and consequently preventing them from growing. The success
of radiation therapy depends on the delivery of an adequate dose
to the entire tumour volume without causing severe damage to surrounding
normal tissues; therefore, the radiation is aimed as accurately
as possible at the tumour. However, healthy cells will be inevitably
affected causing the numerous side-effects of radiotherapy. The
tolerance of healthy tissues to radiation is related to the volume
irradiated, the nature and function of organs within that volume
and the stage of cancer treated.
Sources and Methods of Radiotherapy
Over the last 20 years, the use of radium as a source of radiation
has been replaced with artificial isotopes such as cobalt-60, caesium-137
and iridium-192.
Isotopes may be administered in the following ways:
| • |
implanted directly into tissues (e.g. iridium
needles in the treatment of carcinoma of the tongue). |
| • |
inserted into a cavity (e.g. caesium sources
inserted into the uterus and vagina for the treatment of carcinoma
of the cervix). |
| • |
systemically (e.g. iodine-131 in the treatment
of thyroid cancer). |
External beam radiation therapy: revolutionized in the 1950's,
this method involves the use of linear accelerator machines to generate
a stream of electrons which is accelerated to high speed by microwave
energy before hitting a tungsten target. This interaction results
in the emission of high-energy X-rays. It is thought that this method
ensures the skin receives a lower dose of radiation than with other
methods as the point of maximum dose is 1-2cms below the skin surface.
It is used to treat localized cancers.
In external beam treatments, the maximum therapeutic effect is generally
achieved by employing a practice called ÒfractionationÓ, where the
total dose of radiotherapy is divided into small parts over several
weeks.
Treatment Planning and Dosage
When planning a course of radiotherapy, the following three factors
are taken into account:
| • |
the size of the tumour: a larger number of fractions
will normally be required to eliminate a larger tumour. |
| • |
tolerance of normal tissues: the total dose which
can be applied to a tumour is limited by the tolerance of the
surrounding normal tissue - this varies greatly between tissues. |
| • |
radio-sensitivity of tumour cells: some tumour
cells are more radiosensitive and others are more radio-resistant,
as shown in the table below. |
| Highly radiosensitive |
Moderately radiosensitive |
Relatively resistant |
Very resistant |
| Lymphomas |
Breast cancer |
Squamous cell lung cancer |
Melanoma |
| EwingÕs sarcoma |
Small cell lung cancer |
Hypernephroma |
Osteosarcoma |
| Seminoma |
Ovarian cancer |
Bladder carcinoma |
Pancreatic carcinoma |
| WilmÕs tumour |
Medulloblastoma |
Rectal carcinoma |
|
| Myeloma |
Basal cell carcinoma |
Soft tissue sarcoma |
|
| |
Teratoma |
Cervical carcinoma |
|
|
Table1. Relative radio-sensitivity of tumours.
When is radiotherapy used?
About four out of ten people with cancer have radiotherapy as part
of their treatment. There are five main reasons why radiotherapy
is given in the treatment of cancer:
| • |
Curative or radical treatment - a modality of
local control alternative to surgery. Radiotherapy may be indicated
where a) it will give better functional or cosmetic results
than surgery, b) in the case of very radiosensitive tumours
c) in inoperable tumours, d) at sites where surgery carries
a high rate of morbidity and e) in patients unfit for radical
surgery. |
| • |
Palliative treatment - to relieve symptoms and
reduce pain. The aim is to give sufficient treatment to relieve
symptoms without short-term side-effects for as long as the
patient is expected to survive. |
| • |
Neoadjuvant or induction treatment - before surgery
to shrink a tumour or reduce the risk of it spreading during
surgery. |
| • |
Adjuvant treatment - after surgery to kill off
remnants of the tumour. It may be given to the site of the primary
disease to reduce local recurrence or to sites of potential
metastatic spread. |
| • |
Total Body Irradiation (TBI) - given to patients
prior to a bone marrow transplant. |
Radiation injury
The tissue penetrating power of high-energy X-rays and g-rays means
that normal tissues will be irradiated as well as the tumour. The
important site of radiation damage is nuclear DNA. The damage appears
to be induced indirectly. The radiation first produces highly reactive
radicals which in turn damage the DNA, impairing the reproductive
integrity of the cell. The amount of cell death following exposure
to irradiation is proportional to the dose administered. There are
certain tissues which are damaged acutely by relatively low doses
of irradiation (the energy deposited in a tissue is measured in
gray (Gy; 1 Gy = J/kg):
| • |
Bone marrow: this can regenerate after exposure
to 10Gy, but above this dose permanent aplasia may occur. The
white count and platelet count begin to fall within 10 days
of exposure. |
| • |
Intestine: doses of 10Gy or over cause severe
loss of crypt cells leading to loss of villi and extensive ulceration. |
| • |
Skin: Erythema occurs at doses below 10Gy. At
20 Gy, the skin starts to desquamate and ulcerate. |
| • |
Lung: Above 10Gy in a single fraction, pneumonitis
occurs and is increasingly severe with increase in dose. |
Side-effects
The complications of radiotherapy depend on the radiation sensitivity
of normal tissues in the path of the beam, and may be immediate or
delayed.
| Tissue |
Complication
|
| Immediate |
Delayed |
| Skin |
Erythema,
Desquamation |
Fibrosis,
Telangiectasia
Squamous carcinoma |
| Oral cavity |
Mucosal ulceration |
Loss of saliva |
| Gut |
Nausea, diarrhoea |
Fibrosis and stricture |
| Bone |
Bone necrosis |
Loss of bone growth in children |
| Kidney |
Acute nephritis |
Chronic nephritis Hypertension |
| CNS |
Radiation myelitis and encephalitis |
Demyelination Possible alteration of personality
and intellect |
| Eye |
Conjunctivitis |
Dry eye
Cataract formation |
| Gonads |
Sterility |
Sterility |
| Bone marrow |
Leucopenia |
Suppression of haemopoiesis in area irradiated
|
|
Table 2. Side effects of radiotherapy
The most frequently seen short-term side effects of radiotherapy,
although they will vary depending on the area of treatment, are as
follows:
| • |
local necrosis |
| • |
pain |
| • |
inflammation |
| • |
local exudation with a burning feeling |
| • |
tiredness |
| • |
hair loss |
| • |
diarrhoea |
| • |
loss of appetite and weight |
| • |
shortness of breath |
| • |
difficulty in swallowing |
| • |
loss of taste or metallic taste |
| • |
cystitis |
Obviously side-effects vary depending on the area of the body which
is treated. However, looking at the most common side-effects, we can
attempt to group them according to the following Chinese pathological
patterns:
| • |
Deficiency of Qi, Blood and Yin (of the Stomach,
Spleen, Lungs, Liver and Kidneys)
Hair loss, diarrhoea, bone-marrow suppression, fatigue, loss
of appetite, neurological damage, shortness of breath, loss
of taste. |
| • |
Blood-Heat
Skin reactions, cystitis, burning feeling, local necrosis. |
| • |
Blood stasis
Pain, inflammation, local necrosis. |
The treatment principles to adopt are therefore:
| • |
Tonify Qi Blood and Yin (Huang Qi Radix Astragali
membranacei, Dang Gui Radix Angelicae sinensis, Shou Wu Radix
Polygoni multiflori, Gou Qi Zi Fructus Lycii chinensis, Sheng
Di Huang Radix Rehmanniae glutinosae, Wu Wei Zi Fructus Schisandrae
chinensis, Yu Zhu Rhizoma Poligonati odorati, Zhi Mu Radix Anemarrhenae
asphodeloidis) |
| • |
Cool Blood (Mu Dan Pi Cortex Moutan radicis,
Sheng Di Huang Radix Rehmanniae glutinosae, Zhi Mu Radix Anemarrhenae
asphodeloidis) |
| • |
Invigorate Blood (Mu Dan Pi Cortex Moutan radicis,
Hong Hua Flos Carthami tinctorii, Dan Shen Radix Salviae miltiorrhizae).
|
Analysis of individual herbs in Radio-Support
| • |
Huang Qi: tonify Qi and raise immune response |
| • |
Dang Gui: nourish Blood |
| • |
Hong Hua: invigorate Blood |
| • |
Dan Shen: invigorate Blood |
| • |
Shou Wu: nourish Blood |
| • |
Gou Qi Zi: nourish Blood |
| • |
Wu Wei Zi: nourish Yin |
| • |
Nu Zhen Zi: nourish Yin |
| • |
Zhi Mu: nourish Yin and cool Blood |
| • |
Mu Dan Pi: cool and invigorate Blood |
| • |
Sheng Di Huang: nourish Yin and cool Blood |
| • |
Yu Zhu: nourish Yin |
| • |
Yu Zhu: nourish Yin |
| • |
Gan Cao: harmonize |
Pharmacology of Radio-Support ingredients
I shall report only the pharmacology of the above plants that is
relevant to radiotherapy, immune function, inflammation, digestion
or carcinoma. Thus, for each plant, there are many other pharmacological
actions not reported below. These data are not available for all
of Radio-SupportÕs ingredients.
It should also be noted that such data are reported for reference
only as they reflect a reductionist view of the action of herbs
that is at variance with the Chinese medicine view. Some of the
research studies reported present a doubly-reductionist view: firstly,
they use single herbs and secondly, many of them use single constituents
of a herb. By contrast, Chinese medicine uses only formulae composed
of several herbs. It is a well-known fact that, first of all, the
action of a herb is more than the sum-total of the actions of its
individual constituents and secondly, the synergistic action of
the herbs within a formula is more than the sum-total of its individual
herbs. Furthermore, many of the studies reported are based on animal
experiments which could be criticized on ethical grounds.
HUANG QI
Radix Astragali membranacei
Constituents
2'4'-dihydroxy-5,6-dimethoxyisoflavone, kumatakenin, cholinc, betaine,
polysaccharides, glucoronic acid, folic acid.
Pharmacology
| • |
Enhancement of immune function
The decoction given to mice increased the phagocytic activity
of the reticuloendothelial system. Oral administration or nasal
spray of Huang Qi offered protection against the common cold.
Intraperitoneal administration of the polysaccharides from the
root of Astragalus membranaceus antagonized the atrophy of immune
tissues such as spleen, thymus and intestinal lymph nodes as
well as leukopenia caused by immunosuppressant prednisolone
in mice. Intraperitoneal administration of the homogeneous fraction
of the polysaccharides astragalan I and II increased the weight
and cell number of mouse spleen. Two months of oral treatment
with the herb in subjects susceptible to common cold greatly
increased the levels of SIgA and IgG in the nasal secretion.
|
| • |
Antibacterial effect
In vitro, Huang Qi was effective against Shigella shigae,
Bacillum anthracis, Streptococcus hemolyticus, Corynebacterium
diphtheriae, Diplococcus pneumoniae, Staphyloccus aureus.
|
| • |
Prevention of renal toxicity in chemotherapy
A double-blind trial of 49 patients undergoing chemotherapy
showed that the decoction of Huang Qi Radix Astragali membranacei
and Fu Ling Sclerotium Poriae cocos markedly reduced the incidence
of renal toxicity. Rats with experimentally-induced glomerulonephritis,
when treated with Huang Qi had significantly less proteinuria
than control groups as well as milder pathological tissue changes.
|
| • |
Effect on endurance
Decoction of Huang Qi given to mice significantly increased
their endurance in swimming tests. |
| • |
Endocrine effect in patients undergoing radiotherapy
In a randomized clinical trial, the plasma hydrocortisone level
in stage II carcinoma of the cervix was observed. The average
level in 18 patients before and after irradiation were 8.0 and
6.1 µg/100ml, whereas the before and after levels were 9.5 and
9.1 µg/100ml in patients who received a decoction of Huang Qi
Radix Astragali membranacei and Nu Zhen Zi Fructus Ligustri
lucidi for two months. |
| • |
Anti-inflammatory effect
Intravenous dose of 5 mg/Kg or oral dose of 50 mg/Kg of astramembranin
I inhibited the increase in vascular permeability induced by
serotonin or histamine in rats. |
| • |
Hepatoprotective effect
Intravenous administration of 10 mg/Kg of astramembranin I induced
accumulation of cAMP in rabbit plasma. |
DANG GUI
Radix Angelicae sinensis
Constituents
Ligustilide, n-butylidene phthalide, palmitic acid, beta-sitosterol,
beta-sitosteryl palmitate, sucrose, vitamin B12, nicotinic acid,
folic acid, folinic acid, biotin, vitamin A and E.
Pharmacology
| • |
Effect on coronary flow
Perfusion of the 2% fluid extract into the isolated heart
of guinea pigs significantly dilated the coronary vessels
and increased coronary flow.
|
| • |
Effect on platelet aggregation
The aqueous extract of the root and its ingredient ferulic
acid inhibited rat platelet aggregation and serotonin release.
|
| • |
Effect on immune system
The herb enhanced the phagocytic function of abdominal macrophages
of animals.
|
| • |
Anti-inflammatory effect
The aqueous extract of the root decreased vascular permeability.
The inhibitory activity in mice by oral administration was
comparable to that of aspirin; like aspirin, it also inhibited
the release of 5-HT and other inflammatory substances.
|
HONG HUA
Flos Carthami tinctorii
Constituents
Red pigment carthamin, yellow pigments safflor yellow A, safflor
yellow B, safflomin A, luteolin and 7-O-b-D-glucopyranoside, b-sitosterol
and 3-O-b-D-glucopyranoside.
Pharmacology
| • |
Cardiovascular effect
Intravenous administration of 10mg/kg of the injection solution
of the herb increased coronary flow by 60.4% in the in situ
heart of dogs with catheterized coronary sinus.
|
| • |
Anticoagulation effect
The alcoholic extract of the herb prolonged the clotting time
of the blood, plasma recalcification time and serum thrombin
time, and reduced serum prothrombin time of dogs. The alcoholic
extract and decoction of the herb also inhibited rabbit or
rat platelet aggregation induced by ADP and collagen.
|
| • |
Effect on hypoxic endurance
In rats with acute hypoxic encephalopathy, daily oral dose
of 0.5g of the alcoholic extract of the herb for 5 days and
one intraperitoneal dose of 1g prior to operation resulted
in a 83% survival rate whereas the survival rate in the control
group was 30%. The pathology of ischemic damage was milder
and recovery was faster in the medication group than in the
control.
|
DAN SHEN
Radix Salviae miltiorrhizae
Constituents
Tanshiones I, IIA and IIB, isotanshinones I and II, cryptotanshinone,
isocryptotanshinone, methyl tanshinonate, hydroxytanshinone IIA,
miltirone, 1-dihydrotanshinon I, salviol, protocatechuic aldehyde,
protocatechuic acid, b-(3,4-dihydroxyphenyl) lactic acid, and vitamin
E.
Pharmacology
| • |
Effect on Coronary Circulation
In anaesthetized dogs and cats, intravenous infusion of 3-4g/kg
of the injection solution of the herb significantly increased
coronary flow and reduced coronary resistance. At 4g/kg the
coronary flow was increased by 70.47% and the resistance reduced
by 46.4%.
|
| • |
Anticoagulant and anti-platelet aggregation effects
In vitro experiments showed that the decoction of the herb
was inhibitory on all three stages of the coagulation process.
It transformed fibrinogen to fibirin which then degraded into
FDP (fibrinogen degradation products). The ethanolic extract
of the herb inhibited rabbit platelet aggregation induced
by ADP r collagen. Tanshinone IIA sodium sulfonate inhibited
ADP-induced platelet aggregation of the blood from coronary
patients.
|
| • |
Antimicrobial and anti-inflammatory effects
The 1:1 decoction of the herb inhibited Staphylococcus aureus,
Escherichia coli, Proteus vulgaris, Shigella flexneri and
Salmonella typhi. The total tanshinones showed antiinflammatory
activity in mice. Tanshinones also showed bacteriostatic activity
against Staphylococcus aureus and Mycobacterium sp.
|
| • |
Antihepatotoxic effect
The decoction of the herb was able to decrease the elevated
SGPT and pathologcal changes in rabbits with acute liver damage
induced by CC14. It was also effective in restoring liver
function and preventing liver fibrosis in clinical studies.
|
| • |
Effect on Hypoxia tolerance
The survival period or survival rate of mice or rats under
normobaric or hypobaric hypoxic conditions could be markedly
increased by injection of the herb. The drug decreased the
rate of oxygen consumption and increased the animalsÕ tolerance
to anoxia, which was previously reduced by guanethidine at
a late phase.
|
| • |
Effects on the Immunolgic function
Intramuscular injection of the herb decoction to mice at the
dose of 0.2ml daiy for 5 days markedly increased the macrophage
activity in chicken erythrocytes. The compound injection of
the herb could increase T luphocytes in chronic bronchitis
complicated with pulmonary heart disease, as well as in asthmatic
bronchitis and in chronic bronchitis associated with pulmonary
emphysema.
|
| • |
Action on Metabolism of DNA
Incorporatioin of 3H-thymine-D-deoxyribose into the DNA of
the myocardia of mice with acute anoxia was not significantly
altered by the compound injection of the herb but its incorporation
in spleen as compared with the control was significantly decreased.
The incorporation in the livers of the treatment group, however,
was significantly increased.
|
| • |
Effect on skin diseases
Various therapeutic effects were achieved with injection of
the herb in the treatment of psoriasis, scleroderma, neurodermatitis,
eczema, pruritis, urticaria, BehcetÕs syndrome and erythema
nodosum.
|
SHOU WU
Radix Polygoni multiflori
Constituents
Emidon, physcion, chrysophanol, rhein, chrysolphanol anthrone, 2,3,5,4'-tetrahydroxystilbene
2-O-b-D-glucopyranoside and its 2"- and 3"-O-monogalloyl esters,
3-O-galloyl procyanidin B-2, catechin, epicatechin, 3-O-galloylcatechin,
3-O-galloylepicatechin, polygoacetophenoside, lecithin.
Pharmacology
| • |
Immunologic and adrenocorticotropic effects
The herb significantly increased the weights of the thymus,
peritoneal lymph node and adrenal gland of mice and potentiated
the phagocytosis of murine peritoneal macrophages. It also
antagonized the immuno-suppressive effect of prednisolone
and leukocyte reduction due to prednisolone. The thymus atrophy
and serum g-glubulin reduction in mice were also blocked by
administration of the herb. In adrenoprival mice, administration
of the herb resulted in increase of hepatic glycogen.
|
| • |
Antioxidant activity
The aqueous extract of the herb produced antioxidant activities
both in vitro and in vivo as indicated by its ability to protect
against carbon tetrachloride-induced hepatotoxicity in rats
and to scavenge ferri-heme oxidants generated in an in vitro
system. The antioxidant components were contained in the ethyl
acetate fraction of the extract.
|
| • |
Antibacterial action
In vitro studies showed that the herb was inhibitory againt
Mycobacterium tuberculosis var. hominis and Shigella flexneri.
|
| • |
Effects on neurasthenia
Good therapeutic effects were reported in 141 cases of neurasthenia
with insomnia, treated with the 20% injection and the P. multiflorum
tablet. The medication was superior to chlordiazepoxide, meprobamate,
and bromides in inducing sleep.
|
GOU QI ZI
Fructus Lycii chinensis
Constituents
Betaine, dehydro-a-cyperone and solavetivone, polyene alcohols zeaxanthine,
physalien and cryptoxanthine, b-Sitosterol and melissic acid, 1-O-b-D-glycopyranosyl-(2S,
3R, 4E, 8Z)-2-N-palmitoyloctadecasphinga-4,8-dienine and 1-O-b-D-glycopyranosyl-(2S,3R,4E,8Z)-2-N-(2'hydroxypalmitoyl)octadecasphinga-4,8-dienine,
Pharmacology
| • |
Immunoregulating effects
Daily oral administration of 0.4ml of the 100% water extract
of the fruit of L. barbarum for 3 days or one intramuscular
injection of 0.1 ml of the 100% ethanolic extract significantly
increased phagocytosis of the reticuloendothelial system of
mice. In mice, L. bararum polysaccharides (LBP) at intraperitoneal
dose of 5 or 10mg/kg increased T lymphocyte proliferation.
At 5mg/kg it also enhanced the cytotoxicity of CTL and NK
cells. The splenic plaque-forming cells (PFC) in aged mice
were increased to a normal adult mouse level following intraperitoneal
administration of 1-2mg/kg of LBP.
|
| • |
Adjuvant therapeutic effect on tumours
The herb showed synergistic actions with chemo- and radio-therapy
and reduced their side effects. The inhibition of sarcoma
W256 in rats by cyclophophamide (Cy) was augmented after oral
dose of the aqueous extract of the herb and white cell reduction
due to Cy was attenuated. In another experiment with mouse
brain G422 tumour, combination of LBP with cranial irradiation
of 60Co and BCNU not only increased the life span of the tumour-bearing
mice but also improved cellular immune functions.
|
| • |
Hematopoietic effect
Oral administration of 0.5ml of the 10% decoction daily for
10 days promoted the hematopoiesis in mice, increasing the
number of leukocytes. It also protected from leukocytogenesis-inhibition
by cyclophosphamide. Three daily doses of 10mg/kg of LBP stimulated
the proliferation of the bone marrow stem cells and increased
the number of progenitors of granulocytes and macrophages
of mice.
In 50 healthy subjects taking 50g of the herb daily for
10 days, the white cell count was significantly increased
from 6446±2811 to 7143±2938. The same dosage given to 28 malignant
cancer patients receiving chemotherapy increased the white
cell count from 3909±310 to 6371±2500.
|
| • |
Anti-peroxidation and anti-hepatotoxic effects
The herb showed inhibition on lipid peroxidation of RBC membrane
induced by H-20-2. The effect of free radicals on the cells
was prevented and reversed by incubation with LBP as shown
by determining the changes in electrical parameters of the
cell membrane of Xenopus oocytes. The resting membrane potential
was raised, and the membrane resistance and time constant
were decreased.
|
| • |
Adjuvant cancer treatment
79 advanced cancer patients were treated with LAK/IL-2 combining
with LBP. Initial results of the treatment from 75 valuable
patients indicated that objective regression of cancer was
achieved in patients with malignant melanoma, renal cell carcinoma,
colorectal carcinoma, lung cancer, nasopharyngeal carcinoma
or malignant hydrothroax.
|
WU WEI ZI
Fructus Schisandrae chinensis
Constituents
Lignan compounds including schisandrol A and schisandrin B, citral,
a- and b-chamigrene, and b-chamigrenal, citric acid, malic acid, tartaric
acid, vitamin C, fatty oil.
Pharmacology
| • |
Anti-hepatotoxic effect
Anti hepatotoxic effects of 22 lignans from Schisandra fruit
were evaulated by utilizing CC14 and Ga1N-induced cytotoxicity
in primary cultured rat hepatocytes as model systems. Prominent
protective actions were found with wuweizisu C and schisantherin
D against CC14-produced cytotoxicity. Deoxygomisin A, gomisin
N, Wuweizisu C, gomisin C, and schisantherin D were effective
in preventing Ga1N-induced cell damage.
|
| • |
Respiratory Stimulation
Intravenous administration of the decoction of the herb produced
respiratory stimulating effects in normal and anaesthetized
rabbits and dogs. It increased both frequency and amplitude
of respiration.
|
| • |
Adaptogen-Like and Immune Regulation actions
The fruit can increase the resistance of the body against
nonspecific stimuli. It decreased local oedema due to burns
in mice and increased survival rate and survival time of the
animals.
|
| • |
Neurasthenia
The 40-100% tincture of the herb at 2.5ml twice to three times
daily for a course of two weeks to one month alleviated or
relieved insomnia, headache, dizziness, blurred vision, palpitation
and nocturnal emission.
|
NU ZHEN ZI
Fructus Ligustri lucidi
Constituents
Oleanolic acid, acetyloleanolic acid, betulin, lupeol, salidroside,
mannitol, oleic acid, linolic acid, palmitic acid.
Pharmacology
| • |
Incremental effect on white blood cells
The fruit increased white blood cells in leukopoenia due to
chemotherapy or radiotherapy in mice.
|
| • |
Effect on immune function
The fruit promoted lymphoblast transformation and increased
the number of cells with haemolytic plaques. The in vitro
restorative effect of the aqueous extract of the herb was
studied in cancer patients and in normal, healthy donors.
Using the local graft versus host (GvH) reaction as a test
assay for T-cell function, the extract affected an immune
restoration in 9 of 13 cancer patients with an increase in
local GvH reaction from 32.3/36.1 mm3 to 118/104.9mm3; these
results suggest the herb contains powerful immune stimulants.
|
| • |
Antineoplastic action
The extract given by intragastric administration to mice gave
a 49% inhibition rate against cervical cancer. The extract
of the herb has been found to reverse tumour-associated macrophage
suppression; these data suggest that the herb has cancer chemo-preventative
properties.
|
| • |
Effect on leukopenia
The injection of an extract of the fruit given once or twice
daily could be used in cancer patients to prevent and treat
leukopenia caused by chemotherapy.
|
| • |
Anti-inflammatory effect
Paw oedema in rats was inhibited by oral administration of
12.5 or 25g/kg of the decoction of the herb for 5 days.
|
ZHI MU
Radix Anemarrhenae asphodeloidis
Constituents
Timosaponins A1, A2, A3, and A4, timosaponins B1, B2, etc., sarsasapongenin,
markogenin, neogitogenin, norlignans such as hinokiresinol and oxy-hinokiresinol,
anemarans A-D, xanthone C-glucoside and mangiferin.
Pharmacology
| • |
Antipyretic effect
Subcutaneous injection of the aqueous extract of the rhizome
(4g/kg) decreased the body temperature of rabbits inoculated
with Escherichia coli.
|
| • |
Antimicrobial effect
The rhizome decoction showed in vitro inhibitory effect on
Bacillus dysenteriae, B. typhosus, B. paratyphosus, B. coli,
B. proteus, B. diphtheriae, Vibro comma, Staphylococcus, Diplococcus
pneumoniae, Streptococcus hemolyticus, and Candida albicans.
|
| • |
Effects on blood glucose
The aqueous extract of the herb could lower the blood glucose
level in normal rabbits.
|
MU DAN PI
Cortex Moutan radicis
Constituents
Paenol, paenoside, pasenolide, paeniflorin, volatile oil and phytoesterol.
Pharmacology
| • |
Antimicrobial action
The decoction of the root showed strong antibacterial action
in vitro aginst Bacillus subtilis, Escherichia coli, Salmonella
typhi, Salmonella paratyphi, Proteus vulgaris, Staphylococcus
aureus, Streptococcus haemolyticus, Doplococcus pneumonia
and Vibrio cholerae.
|
| • |
Anti-inflammatory action
Paenol given intragastrically inhibited swelling of rat paws
induced by dextran. Paenol inhibited the increase of intra-abdominal
capillary permeability of mice and cutaneous capillary permeability
of guinea pigs caused by acetic acid. The methanolic extract,
the glycosidic fraction and paenol inhibited blood platelet
aggregation.
|
| • |
Hypotensive effect
The blood pressure of dogs with essential or renal hypertension
was significantly reduced after oral administration of 5g/Kg
of the decoction of the root bark for 5 days and 10g/Kg for
two more days.
|
| • |
CNS effects
Intraperitoneal or oral administration of paenol decreased
the spontaneous activity of mice, antagonized caffeine-induced
hyperactivity and prolonged cyclobarbital-induced sleep.
|
GAN CAO
Radix Glycyrrhizae uralensis
Constituents
Triterpenes glycyrrhizin, flavonoids berniarin, umbelliferone, ferulic
acid, sinapic acid, amino-acids, biotin, beta-sitosterol.
Pharmacology
| • |
Glucocorticoid-like action
Injection of glycyrrhizin in healthy subjects increased free
cortisol levels in the blood. Intraperitoneal administration
of a low dose of glycyrrhizin to rats caused atrophy of the
thymus gland and increased weight of the adrenal gland suggesting
a cortico-tropin-like action; in patients with mild AddisonÕs
disease requiring daily intramuscular injection of 12.5mg
of cortisone, concurrent daily intramuscular dose of glycyrrhizin
increased urinary free 17-hydroxycorticosterone and decreased
the conjugated 17-hydroxycorticosterone.
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| • |
Mineralocorticoid-like action
The extract reduced the urinary volume and sodium excretion
and increased potassium excretion in various animal species.
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| • |
Anti-inflammatory action
The anti-inflammatory effect of the herb resembles that of
butazone or hydrocortisone; cotton pledget-induced granulation,
formaldehyde-induced paw swelling and subcutaneous granulomatous
inflammation in rats were all inhibited by glycyrrhetic acid.
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| • |
Effect on the immune system
Glycyrrhizin inhibited egg-white-induced allergic reaction
in guinea pigs. Glycyrrhizin inhibited the degranulation of
mast cells elicited by the histamine liberation agent, Compound
48/80, so that it suppressed the release of the allergy mediators.
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| • |
Anti-ulcer action
Injection of the herb extract produced significant inhibition
of ulcers in albino rats, together with marked reduction in
gastric juice and free acid. In many clinical studies on the
use of Gan Cao for ulcers, the effectiveness was usually around
90%.
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| • |
Anti-neoplastic action
Glycyrrhetinic acid inhibited the transplanted Oberling-Guerin
myeloma in rats.
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| • |
Effect on lipid metabolism
In rats with atherosclerosis, Gan Cao lowered cholesterol
levels and stopped the progression of the lesions.
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| • |
Antihepatotoxic effect
Oral administration of the extract of the herb showed hepatoprotective
effects against carbon tetrachloride-induced cytotoxicity
in rats; it markedly abated hepatic degeneration and necrosis,
promoted the recovery of hepatocellular glycogen and ribonucleic
acid and also lowered serum glutamic pyruvic transaminase.
Glycyrrhizin and glycyrrhetic acid are able to prevent the
development of cirrhosis.
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CHEN PI
Pericarpium Citri reticulatae
Constituents
Dlimonen, citral, hesperidin, neohesperidin, tangeretin, nobiletin,
citromitin, 5-O-desmethylcitromitin, inositol, Vitamin B1.
Pharmacology
| • |
Actions on the gastro-intestinal smooth muscles
The herb decoction inhibited the motility of the isolated
small intestines of mice and rabbits.
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| • |
Action against gastric ulcers
Daily injections of methylhesperidinfor 6 days markedlly reduced
the incidence of ulcers and inhibited gastric secretions.
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| • |
Anti-inflammatory action
Both hesperidin and methylhesperidin had vitamin P-like actions.
Hesperidin inhibited the inflammatory reaction of croton oil
granulation in rats. Intraperitoneal dose of 10mg/Kg of hesperidin
inhibited increased permeability caused by histamine in mice.
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YU ZHU
Rhizoma Poligonati odorati
Constituents
Convallamarin, convallarin, odospiroside, polyfuroside and POD-II,
or 3-O-b-glucopyranosyl - (1®2) - (b-D-xylopyranosyl - (1®3)-b-D-glucopyranosyl
- (1®4)-galactopyranosyl - 25(R) - spirost-5-en-3-b,14a-diol, quercetin
glycoside, kaempferol, vitexin-2"-O-sophoroside, cosmosiin, vitexin,
vitexin-2"-O-dlucoside, saponarin.
Pharmacology
| • |
Immunostimulating effect
Oral administration of 10.4g/kg of the ethanolic extract of
the herb to mice with burn injury markedly increased serum
hemolysin level, stimulated antibody production and phagocytosis
of the peritoneal macrophages. The hot water extract of the
herb also stimulated phagocytes as measured with carbon clearance
activity in mice
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| • |
Effect on blood glucose
Intramuscular administration of 0.5g/kg of the macerate of
the herb to rabbits increased blood glucose, but oral administration
resulted in reduction of blood glucose after an initial increase.
Oral dose of the macerate also decreased blood sugar levels
in rats with diabetes induced by epinephrine, glucose or alloxan.
In mice the methanolic extract of the herb produced anti-diabetic
effect against epinephrine- or streptozotocin-induced hyperglycemia.
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| • |
Action on smooth muscles
The 20% decoction of the herb initially excited the isolated
intestine of mice and inhibited it thereafter; it had a weak
excitatory action on the isolated uteri of mice.
|
SHENG DI HUANG
Radix Rehmanniae glutinosae
Constituents
Catalpol, ajugol, leonuride, aucubin, melittoside, rehmanniosides
A-D (glycosides). E-feruloylajugol, Z-feruloylajugol, p-coumaroylajugol,
p-hydroxybenzoylajugol, vanilloylajugol, 4-(a-L-rhamnopyranoxyloxy)-3-methoxybenzoylajugol
(ajugol esters). Jioglutoside A and jioglutoside B (iridoid glycosides).
Acetoside, isoacetoside, purpureaside C, echinacoside, castanosides
A and F, rehmaglutins A-D, glutinoside, rehmaionosides A, B and C,
rehmapicroside, b-sitosterol, mannitol, campesterol.
Pharmacology
| • |
Effects on adrenocortical function and cortisol metabolism
The herb was able to stop the decrease of plasma corticosterone
concentration due to administration of dexamethasone and prevent
the adrenal cortex from atrophy.
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| • |
Anti-inflammatory and immuno-suppressive effects
Formaldehyde-induced oedema of rat paws subsided after oral
administration of the decoction or alcoholic extract at the
daily dose of 10g/kg for 5 days. At the oral dose of 100mg/kg,
jionoside B and acetoside produced 36% and 18% suppression
of hemolytic plaque forming cells in the spleens of mice.
In the same test conditions intraperitoneal dose of 30mg/kg
of cyclophosphamide had a 52.5% suppression.
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| • |
Effect on Hemorheology
The effects of the herb on the hemorheology of inflammatory,
thrombosic and intact animals were examined. Oral administration
of 200mg/kg of the 50% ethanolic extract of the herb inhibited
the reduction of fibrinolytic activity and erythrocyte deformability,
the decrease in erythrocyte counts and the increase in connective
tissue of the thoracic artery in a chronic inflammatory model,
adjuvant-induced arthritis.
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| • |
Antiradiation effect
The 100% injection solution of the root given intraperitoneally
at 1ml daily for 6 days mitigated platelet damage in rats
caused by 600 rad of g-irradiation. The aqueous extract of
the root inhibited in vitro fungi mentagrphyton, Microsporum
gypseum and M. audouini. The decoction of the root showed
protective effect in mice against CC14-caused liver intoxication.
Oral or intraperitoneal administration of 10g/kg of the decoction
or the alcoholic extract potentiated the hypnotic effect of
pentobarbital sodium. Intraperitoneal dose of 20g/kg of the
decoction or the alcoholic extract protected mice from hypobaric
hypoxia.
|
Radio-support works better if it is started some time before the beginning
of radiotherapy and continued for about six months after the end especially
for radiotherapy in the abdominal cavity. It is important to note
that Òduring the treatmentÓ means during the course of treatment,
i.e. also in the days of break from the treatment. The dosage is as
follows:
Two weeks before start of treatment: 2 tablets twice a day
Four days before the start of treatment: 2 tablets three times a day
During the treatment: 3-4 tablets three times a day
After the end of the treatment for about 6 months: 2 tablets three
times a day
It is best to take the tablets away from meals. i.e. about 1 hour
before or after a meal, swallowed with hot water. The tablets should
also be taken separately from other medication, at least 1 hour away.
If the patient feels very nauseous and finds it difficult to swallow
the tablets, these could be crushed and powdered, immersed in a small
amount of hot water with three slices of fresh ginger and the water
sipped slowly.
The dosage during treatment indicated above should be adjusted according
to the severity of the side-effects and the above dosage could be
reduced or increased.
If the patient is receiving both radio- and chemo-therapy and is taking
both Radio-Support and Chemo-Support, the dosage of each should be
reduced. Adjustments can be made according to the patientÕs side-effects
and timing of therapies in this situation by using a higher ratio
of Radio-Support during days surrounding radiotherapy or when its
side-effects are heightened. Similarly, the dosage of Chemo-Support
can be increased if the side-effects experienced from chemotherapy
are more severe, or during the days surrounding the administration
of chemotherapy.
Radio-Support should be discontinued approximately six weeks after
the end of the treatment when the condition should be reassessed and
a different formula given to treat the condition underlying the original
cancer.
Acupuncture used along side Radio-Support can further help
to reduce the side-effects of radiotherapy. Furthermore, it has the
additional advantage that it can be tailored to the specific side-effects
of the individual patient. The following are suggested point combinations
for specific symptoms and signs.
Fatigue
Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21
Weishu.
Nausea and vomiting
Ren-13 Shangwan, P-6 Neiguan, ST-34 Lianqui, ST-36 Zusanli. In addition
to acupuncture, the following massage technique is very effective
to combat nausea and vomiting: apply a massage oil liberally to the
lower legs, make a loose fist with your hands, starting from ST-36,
massage downwards along the Stomach channel using the knuckles of
the index fingers all the way down to the ankle and then massage upwards
along the spleen channel using your thumbs. This technique harmonizes
the ascending and descending of Stomach- and Spleen-Qi, stimulating
Stomach-Qi to descend and Spleen-Qi to ascend.
Loss of appetite
ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Ren-12
Zhongwan.
Loss of taste
ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Ren-12
Zhongwan, L.I.-4 Hegu.
Diarrhoea
ST-25 Tianshu, ST-37 Shangjuxu
Stomatitis, mouth ulcers
ST-44 Neiting, L.I.-4 Hegu, L.I.-11 Quchi.
Metallic taste
LIV-2 Xingjian, LIV-3 Taichong, L.I.-4 Hegu, L.I.-11 Quchi, Ren-12
Zhongwan.
Alopecia
BL-17, Geshu (with direct moxa cones), BL-11 Dashu (with direct moxa
cones), BL-20 Pishu, BL-23 Shenshu.
Cystitis
Ren-3 Zhongji, BL-63 Jinmen, BL-28 Pangguangshu, BL-32 Ciliao, SP-9
Yinlingquan.
Fever
L.I-11 Quchi, KI-2 Rangu, Du-14 Dazhui.
Skin rash
L.I.-11 Quchi, SP-10 Xuehai.
Shortness of breath
LU-7 Lieque, LU-9 Taiyuan, BL-13 Feishu, Du-12 Shenzhu, BL-43 Gaohuangshu.
Difficulty in swallowing
Ren-23 Lianquan, L.I.-4 Hegu, LIV-3 Taichong.
BIBLIOGRAPHY
| • |
Levitt S, Kahn F, Potish R, Perez C, Technological
Basis of Radiation Therapy, Lippincott, Williams and Wilkins,
Maryland 1992. |
| • |
Souhami R, Moxham J, Textbook of Medicine,
Churchill Livingstone, Edinburgh, 1994. |
| • |
Zhu YP, Chinese Materia Medica, Harwood
Academic Publishers, Amsterdam, 1998. |
| • |
Chang H.M. and But P.P. Hay, Pharmacology
and Applications of Chinese Materia Medica, World Scientific,
Hong Kong, Vols. I and II, 1986. |
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