Chinese Herbs for the Elderly, Part 2

A  good overview of different Chinese medicines beneficial for elderly ills is “Systematic review of traditional Chinese medicine for geriatrics,” Geriatrics & Gerontology International, 2017, 17: 679-688. Accessed April 25, 2018.

This lengthy article reports in depth on a review of Traditional Chinese Medicine (TCM) in connection with revised criteria of the Japan Geriatrics Society for medical treatment and safety of the elderly.

The authors used a literature search with multiple search terms for various synonyms for the elderly and specific therapeutics including “East Asian Traditional Medicine, Kampo Medicine,
Chinese Traditional Medicine, Chinese herbal drugs, herb–drug interaction, herbal medicine, medicinal plant, plant components, plant extracts, phytotherapy, phytomedicine, Kampo, Oriental medicine, Japanese traditional medicine, Korean medicine, acupuncture and moxibustion.”

Treatments identified in this review that may improve symptoms of the following diseases in older adults are: “dementia and mild cognitive impairment (cognitive function, behavioral and psychological symptoms of dementia), post-stroke symptoms (activities of daily living, depression, aspiration pneumonia and constipation), chronic obstructive pulmonary disease, hyperlipidemia, foot ulcer as a result of diabetes mellitus, osteoporosis, post-abdominal surgery complications, chronic constipation, the prevention and treatment of influenza, angina pectoris, and hypertension.”

Tables report on the medicines, ingredients, effects, attention (concerns/adverse effects) and the Quality of Evidence rating. Additional medicines not available in Japan are listed in a separate table. A third table lists a screening tool for herbs that should be used with the elderly with cautions on dosages or specific associated effects from other drugs.

Another report talks about a drug useful in preventing nosocomial infections in the elderly. Given the prevalence of these infections in U.S. hospitals, this might be especially useful since the results found a significant decrease among susceptible individuals. See “Prevention of traditional Chinese medicine Gubiao Pixie prescription for nosocomial infection in elderly population,” Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 May; 29(5):469-472. Accessed April 25, 2018. A lengthy abstract in English is available at the link.

This article in the Journal of Ethnopharmacololgy. 2012 Mar 27;140(2):345-67, “Emerging approaches of traditional Chinese medicine formulas for the treatment of hyperlipidemia,” may be useful. It reports on multiple TCM formulas. Listed in the abstract are Fructus Crataegi, Radix Polygoni Multiflori. Semen Cassiae, and Radix et Rhizoma Rhei, Rhizoma alismatis  and Herba Artemisiae Scopariae, Radix Salviae Miltiorrhizae, Radix Puerariae, Rhizoma Chuanxiong, Flos Carthami), and Folium Nelumbinis, Fructus Lycii, Radix Ginseng, and Radix Astragali. Also noted at the very end is this comment: ”However, solid evidence of the efficacy of these treatments is required.”

The Quest for Herbal Aphrodisiacs

Mankind’s search for ways to improve sexual capabilities or “fix” the problem of erectile dysfunction has been a preoccupation for at least as long as recorded history.  There probably is a high likelihood that primitive man, when oral tradition was the only way to maintain a history, found and passed on knowledge about natural substances that seemed to offer help in this area. The word aphrodisiac itself is more recent, coming from the Greek Goddess of Love, Aphrodite. It did not matter whether the location was in the East, West, North or South, the goal has been around for a very long time.

It is quite easy now for anyone with access to the Web to search for and find supposed cures or aids for sexual issues. Here are a few examples: Horny Goat Weed, Korean Ginseng, Rhodiola Rosea, Yohimbe. How useful and safe the herbs located this way may be, particularly when they have a combination of ingredients, is not so easy to determine.

Some basic searching in medical databases such as the National Library of Medicine’s, pubmed.gov reveals an astonishing and truly overwhelming amount of research on the topic involving both human and rats/mice subjects. One review alone has 64 reference citations. In slightly more than 20 years, the weight of published research has shot up remarkably, particularly since the release of the prescription drug Viagra (sildenafile citrate).

An obvious driving impetus for research on herbal sources came from presumed fewer side effects and lower costs given the generally wide available nature of many herbs. Facilitating the search was a long tradition of folk remedies. The weakness of this approach so far is the lack of sufficient reliable, clinical evidence of the exact mechanism of herbal treatments as well as sufficient safety data in humans. Hopefully, with more attention and studies, some true improvements in caring for these seemingly endemic conditions in Man may someday make real, verifiable treatments available for those in need.

To go into detail about each plant described and tested in a simple blog post is impossible. The most this article can do is provide links to medical articles for the reader to pursue if desired. A helpful feature about searches on pubmed.gov is that frequently related articles will be listed on the right of the screen for more information. Several extensive reviews are listed below with brief comments from the body of the articles. Some of these report positive results, often in animal studies but some in human. There are still a number of doubts in the medical field about the efficacy of herbal supplements on human sexual problems. The third report below is one example of this kind of negative finding.

The best approach for laymen interested in this subject is to conduct further research on http://pubmed.gov with the following search strategy and the herbs listed in these reviews or found  through checking the full Web. Use as many herbs in the sample as you desire without the quotation marks or brackets but with the parentheses, i.e., “[panax ginseng] AND (aphrodisiac OR erectile).” Substitute each succeeding herb for panax ginseng in this example.

If you want to try any of the advertised commercial products, at least attempt to identify the contents and check them out using  pubmed.gov and other reliable sources such as http://consumerlab.com or go directly to a subset of pubmed, the National Center for Complementary and Integrative Health at  https://nccih.nih.gov/research/camonpubmed. Check this last source particularly for recalls on supplements like the ones you find.

Pharmacognosy Reviews . ”Exploring scientifically proven herbal aphrodisiacs,” Sabna Kotta, Shahid H. Ansari and Javed Ali, 2013 Jan-Jun; 7(13): 1–10.

               “The hunt for natural supplement from medicinal plants is being intensified mainly because of its fewer side effects. In this review, we have mentioned the pharmacologically tested (either in man or animal or in both) aphrodisiac plants, which have claimed for its uses.” (This review contains two very useful tables. One lists herbs with the parts used, chemical constituents and probable mechanism of action. The second gives the constituents of various herbal compendiums available commercially.

 Acta Poloniae Pharmaceutica—Drug Research. “Recent studies on aphrodisiac herbs for the management of male sexual dysfunction: a review,” Neelesh Malviya, et al., 2011, Vol. 68 No. 1 pp. 3-8.

               “Aphrodisiacs can be categorized according to their mode of action into three groups: substances that increase libido (i.e., sexual desire, arousal), substances that increase sexual potency (i.e., effectiveness of erection) and substances that increase sexual pleasure.”

  The Journal of Sexual Medicine. “Natural aphrodisiacs,” Shamloul R , 2010 Jan;7(1 Pt 1):39-49.

“There is little evidence from literature to recommend the usage of natural aphrodisiacs for the enhancement of sexual desire and/or performance.” “The current body of objective evidence does not support the use of any natural aphrodisiac as an effective treatment for male or female sexual dysfunctions. Potent men and men with ED will continue the search for natural aphrodisiacs despite the current disappointing data on their effectiveness. Care should be taken regarding the fraud addition of sildenafil analogues to natural aphrodisiacs.”

 

 

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Chinese Herbs for the Elderly, Part 1

After thousands of years using traditional Chinese medicine (TCM) for many conditions in the East, the potential benefits of these treatments gradually are being accepted in some areas of Western Medicine.  The West has a general bias towards evidence-based, clinical studies documenting efficacy, making this acceptance a slow haul. Articles in respected Western-published medical journal finally are becoming more prevalent, although treatments such as Chinese Herbal Medicine (CHM) are still considered complementary or adjunctive. 

Acupuncture acceptance has spread in the West faster than another important feature in TCM, Chinese Herbal Medicine (CHM). With the focus of allopathic medicine on specific drugs for specific conditions as opposed to CHM’s emphasis on treating the whole body it will take some time for this methodology to gain more acknowledgement.

In dealing with seniors, treatments such as CHM may have potential benefits by being able to mitigate some of the side effects inherent in prescription drugs that can be more dangerous in aging patients.  These dangers arise primarily from several natural causes: 1) because of the concomitant decline of renal and hepatic functionality as people age; 2) common comorbid diseases such as hypertension, diabetes, and elevated hyperlipidemia; and 3) frequently reduced immune systems. Given these factors, it is natural that adverse effects of drugs might have more dangers in the elderly than in younger patients.

This and the next blog post will examine some important research in how CHM is being used along with Western medicine.

Writing in the Journal of Geriatric Cardiology in 2013, three Chinese doctors described a study on the potential benefits of CHM for elderly patients with cardiovascular diseases [i] . The article first calls attention to typical adverse effects after traditional antithrombotic treatments as well as operations like coronary bypass surgery—”bleeding, orthostatic hypotension, bradycardia, or congestive heart failure . . .,” plus “an unfavorable quality of life resulting from drug-related gastrointestinal reactions, depression, dizziness, and cognitive impairment.”

The article cites experimental studies of Cardiovascular (CVD) treatment with some Chinese herbs, Ren Shen (Radix Ginseng), Chuan Xion (Rhizoma Canxiong) and Dan Shen (Radix Salviae Miltiorrhizae). There are additional references to clinical trials of CHM combinations,  Xiongshao capsule, Tong Xin Luo capsule and Danshen dripping pill, that led to multiple beneficial effects after traditional Western treatment for CVD. Results confirmed that these herbs:

Can improve the health-related quality of life, lower the restenosis rate after Percutaneous Coronary Intervention (PCI), reduce cardiovascular events, improve electrocardiogram (ECG) and serum myocardial injury biomarkers, decrease consumption of some chemicals, etc. Furthermore, only few mild side effects with spontaneous remission, such as abdominal distention from common CHM in elderly patients with CVDs can be found clinically.

The authors concluded by saying that while CHM benefits were not as strong as specific prescription drug treatments on the process of CVD, “CHM is indeed an alternative and complementary choice for elderly patients with CVDs due to its holistic regulation, individualized and complex intervention, as well as fewer side effects.”

Additional applications of CHM for the elderly will be covered in Part 2.
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[i] Jing Luo, Hao Xu, and Ke-Ji Chen, “Potential benefits of Chinese Herbal Medicine for elderly patients with cardiovascular diseases,” Journal of Geriatric Cardiology, 2013 Dec; 10(4); 305-309. Accessed April 6, 2018.