A Review of the Status of Western Herbal Medicine in Australia

Progress in Immunoassays of Toxic Alkaloids in Plant-Derived Medicines: A Review

Plants are the cradle of the traditional medicine system, assuaging human or animal diseases, and promoting health for thousands of years. However, many plant-derived medicines contain toxic alkaloids of varying degrees of toxicity that pose a direct or indirect threat to human and animal health through accidental ingestion, misuse of plant materials, or through the food chain. Thus, rapid, easy, and sensitive methods are needed to effectively screen these toxic alkaloids to guarantee the safety of plant-derived medicines. Antibodies, due to their inherent specificity and high affinity, have been used as a variety of analytical tools and techniques. This review describes the antigen synthesis and antibody preparation of the common toxic alkaloids in plant-derived medicines and discusses the advances of antibody-based immunoassays in the screening and detection of toxic alkaloids in plants or other related matrices. Finally, the limitations and prospects of immunoassays for toxic alkaloids are discussed.

Mechanistic Insights from the Review and Evaluation of Ayurvedic Herbal Medicines for the Prevention and Management of COVID-19 Patients

Introduction

The need for specific therapeutics against infectious diseases is made very important at this moment by the COVID-19 pandemic caused by SARS-COV-2. Vaccines containing live attenuated or heat-inactivated pathogens elicit robust immune responses, but their safety is sometimes not assured. Subunit vaccines consisting of the most potent antigenic protein or carbohydrates of the pathogen are safer but often induce a weak immune response. Traditional Ayurveda medicines have a long history of safety and may act as immuno-modulators or vaccine adjuvants. They can reduce the amount of vaccine booster doses required to elicit an immune response against any pathogen. The main objective of this review is a mechanistic evaluation of the antiviral potential of Ayurveda herbal compositions for their ability to increase cytokine expression and enhance NK cell activity, activate CD4/ CD8 + T cells, and increase the formation of IL-2 and IFNγ against SARS-CoV-2 infection.

Methods

Various peer-reviewed publications, books, monographs, and reputed search engines were reviewed in depth. Information available from the Ayurvedic Pharmacopoeia and in recent in silico analyses were compared in order to understand the mechanism of action of herbal components against SARS-CoV-2.

Results

It was found in various molecular docking and molecular dynamics studies that many bioactive natural components of Ayurvedic medicines could prevent viral entry or multiplication within a human host.

Conclusion

Ayurvedic herbal medicines can be used either independently as therapeutics or as a complement to the modern-day recombinant vaccines with immediate effect. Ayurveda-based adjuvant therapy can also efficiently manage the secondary symptoms of COVID 19 patients.

Understanding the phytochemistry and molecular insights to the pharmacology of Angelica archangelica L. (garden angelica) and its bioactive components

Plant-derived molecules have enduring usefulness in treating diseases, and herbal drugs have emerged as a vital component of global therapeutic demand. Angelica archangelica L. (A. archangelica), commonly known as garden angelica, is an aromatic food plant used in culinary procedures as a flavoring agent. In the traditional medicine system, it is regarded as an "Angel plant" due to its miraculous curative power. This review aims to provide a comprehensive summary of the plant's taxonomic profile, ethnopharmacology, Phytochemistry, and pharmacological activities. Various in vivo and in vitro experiments have validated that the plant possesses broad pharmacological potential. The biological activities attributed to the plant include anti-anxiety activity, anti-convulsant activity, cognition enhancer, antiviral activity, cholinesterase inhibitory potential, antiinflammatory activity, gastroprotective activity, and radioprotective activity. The beneficial effects of the plant are credited to its bioactive components, that is, coumarins and volatile oils. The review summarizes the pharmacological activities of crude extract and its bioactive fractions and has also explored their target-oriented effects. This review will be of value in undertaking further investigations on the plant with regard to exploring mechanism-based pharmacological approaches on A. archangelica.

A naturalistic study of herbal medicine for self-reported depression and/or anxiety a protocol

BACKGROUND

Mental health conditions including anxiety and depression account for around 8% of the global disease burden. Anxiety and depression often coexist and impose a high individual and social burden. Patients with mental and behavioural conditions may be at increased risk of co-morbidities and are often high health-care utilisers. Herbal medicine is estimated to be used by up to 80% of the worlds population, and by 22% of Australian women seeking care for depression. The holistic and tailored treatment approach offered by practitioners of herbal medicine is difficult to capture in randomised controlled trials and as such there is a paucity of research demonstrating the outcomes of real-life practice. This project aims to address this gap with a whole practice, observational model.

METHODS/DESIGN

The study will employ a naturalistic observational design. Two-hundred patient participants will be recruited to be treated by 15 clinician participants from different naturopathic clinics. The observed changes in anxiety and depression symptoms of patients will be documented across three consultations using validated patient-reported outcome measures (SF-36, DASS-21, GHQ-28 and POMS-2).

CONCLUSION

Clinical studies investigating the efficacy of individualised herbal medicine treatment as prescribed by a naturopath are rare. Our study attempts to fill this gap with a longitudinal observation of individualised care as practiced by naturopaths in Australia; to offer valuable insights into the effectiveness of individualised herbal medicine practice and provide contextualisation of data currently focused on individual herbal medicines in specific conditions.Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12616000010493.

Transformation of traditional knowledge of medicinal plants: the case of Tyroleans (Austria) who migrated to Australia, Brazil and Peru

BACKGROUND

In ethnobotanical research, the investigation into traditional knowledge of medicinal plants in the context of migration has been of increasing interest in recent decades since it is influenced and changed by new environmental and social conditions. It most likely undergoes transformation processes to match the different living circumstances in the new location. This study compares the traditional knowledge of medicinal plants held by Tyroleans - and their descendants - who emigrated to Australia, Brazil and Peru at different time scales. The study's findings allow a discussion of the complexities and dynamics that influence this knowledge within the context of long-distance migration.

METHODS

Information was obtained from 65 informants by free-listing, semi-structured interviews and non-participatory observation in Tyrol (Austria) and the migrants' countries: Australia, Brazil and Peru. The collected data was analysed using different quantitative approaches, including statistical tests, and compared between the countries of investigation.

RESULTS

All respondents in all four investigation areas claimed that they had knowledge and made use of medicinal plants to treat basic ailments in their day-to-day lives. Informants made 1,139 citations of medicinal plants in total in free lists, which correspond to 164 botanical taxa (genus or species level) in Tyrol, 87 in Australia, 84 in Brazil and 134 in Peru. Of all the botanical taxa listed, only five (1.1%) were listed in all four countries under investigation. Agreement among informants within free lists was highest in Tyrol (17%), followed by Peru (12.2%), Australia (11.9%) and Brazil (11.2%). The proportion of agreement differs significantly between informants in Australia and Tyrol (p = 0.001), Brazil and Tyrol (p = 0.001) and Peru and Tyrol (p = 0.001) and is similar between informants in the migrant countries, as indicated by statistical tests. We recorded 1,286 use citations according to 744 different uses (Tyrol: 552, Australia: 200, Brazil: 180, Peru: 357) belonging to 22 different categories of use. Use values are significantly different between Tyrol and Australia (p < 0.001) but not between Tyrol and Brazil (p = 0.127) and Tyrol and Peru (p = 0.853). The average informant agreement ratio (IAR) in Tyrol is significantly higher than in Australia (p = 0.089) and Brazil (p = 0.238), but not Peru (p = 0.019).

CONCLUSIONS

Changing ecological and social conditions have transformed and shaped traditional knowledge of medicinal plants through adaptation processes to match the new circumstances in the country of arrival. Continuation, substitution and replacement are strategies that have taken place at different rates depending on local circumstances in the research areas. Traditional knowledge of medicinal plants acquired in the home country is continuously diminishing, with its composition influenced by urbanisation and ongoing globalisation processes and challenged by shifts from traditional healing practices to modern healthcare facilities.

Modulation of diabetic retinopathy pathophysiology by natural medicines through PPAR-γ-related pharmacology

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes and remains a major cause of preventable blindness among adults at working age. DR involves an abnormal pathology of major retinal cells, including retinal pigment epithelium, microaneurysms, inter-retinal oedema, haemorrhage, exudates (hard exudates) and intraocular neovascularization. The biochemical mechanisms associated with hyperglycaemic-induced DR are through multifactorial processes. Peroxisome proliferator-activated receptor-γ (PPAR-γ) plays an important role in the pathogenesis of DR by inhibiting diabetes-induced retinal leukostasis and leakage. Despite DR causing eventual blindness, only a few visual or ophthalmic symptoms are observed until visual loss develops. Therefore, early medical interventions and prevention are the current management strategies. Laser photocoagulation therapy is the most common treatment. However, this therapy may cause retinal damage and scarring. Herbal and traditional natural medicines may provide an alternative to prevent or delay the progression of DR. This review provides an analysis of the therapeutic potential of herbal and traditional natural medicines or their active components for the slowdown of progression of DR and their possible mechanism through the PPAR-γ pathway.

Effects of four medicinal herbs on human vascular endothelial cells in culture

BACKGROUND

Danshen (DS, Salvia miltiorrhiza), Shanchi (SQ, Panax notoginseng), Shanzai (SZ, Hawthorn) and Heshouwu (HSW, Polygonum multiflorum Thunb) are four medicinal herbs commonly used in traditional Chinese medicine and previously shown to have activity that may contribute to cardiovascular protection. This study aims to investigate effects of these herbs on vascular endothelial cells with respect to cell viability and expression of cellular adhesion molecules under inflammatory conditions.

METHODS

Herbal extracts were prepared by an established industrial manufacturing process. Human umbilical vein endothelial cells (HUVEC) were incubated with the herbal extract under normal or serum-free culture and tumor necrosis factor (TNF) alpha stimulation. Cell apoptosis, apoptosis-associated gene expression, expression of cellular adhesion molecules, DNA synthesis, and growth were assessed via morphological examination, Annexin-V staining, Western blotting analysis, Flow-Cytometry, [(3)H]-thymidine incorporation assay, and cell number study.

RESULTS

SZ and HSW significantly inhibited apoptosis in HUVEC undergoing serum deprivation and TNFalpha stimulation, accompanied by down-regulation of caspase-3 gene expression. DS and SQ significantly attenuated TNFalpha-induced expression of adhesion molecule VCAM-1 and also ICAM-1 by DS in the cells. All four herbs at therapeutic concentrations (100 microg/mL) inhibited DNA synthesis (10-42% decrease in [(3)H]-thymidine incorporation rates) and growth (5-10% decrease in cell numbers) in HUVEC under normal cultures.

CONCLUSION

DS, SQ, SZ and HSW are physiologically active on human vascular endothelial cells. The actions by HSW and SZ to reduce apoptosis and DS and SQ to inhibit adhesion molecule expression may help protect endothelial function and inhibit atherogenesis, while their actions to inhibit DNA synthesis and cell growth may weaken the ability of endothelial repair. Further studies are needed to identify the chemical compounds responsible to these physiological effects by these herbs.

An examination of the clinical practices and perceptions of professional herbalists providing patient care concurrently with conventional medical practice in Australia

OBJECTIVE

To examine the clinical practices and perceptions of herbalists providing patient care concurrently with conventional medical practice.

METHOD

A postal survey was sent to all full members of the National Herbalists' Association of Australia (NHAA). There were 649 members in practice at the time of the survey and the total response rate was 58.2%.

RESULTS

Most of the patients who visit professional herbalists seek care for chronic conditions have been medically diagnosed and continue to consult a general practitioner (GP). Study findings indicate that many patients who visit herbalists are taking herbal and pharmaceutical medicines concurrently. Therapists reported a high rate of referral to GPs for medical diagnosis, treatment and/or prescription. The majority of herbalists also routinely include a pharmaceutical case history as part of their consultation and patients are encouraged to inform their GPs if they are taking any herbal therapies. The majority of herbalists reported a need for closer collaboration and cooperation with the medical community in the future.

CONCLUSION

Herbalists in Australia are fully aware of the value of medical diagnosis and inter-referrals, are well informed about patient medications and require a closer working relationship with the medical community. Further research is needed to investigate potential interactions between herbal and pharmaceutical medicines to maintain high safety standards for the public.

An examination of the prescription and dispensing of medicines by Western herbal therapists: a national survey in Australia

OBJECTIVE

To describe the patterns of prescription and dispensing of herbal medicines employed by Western herbal practitioners in Australia.

DESIGN

A national postal survey sent to all full members of the National Herbalist Association of Australia (NHAA).

SETTING

Nationwide clinics of professional herbal practitioners in Australia.

MAIN OUTCOME MEASURES

Measures of medicinal use were collected including aspects of prescription, formulation, dispensing and preparation forms of medicines used. The practitioners were asked if they dispensed their own medicines, about the form of herbal preparations used, aspects of formulation and dosages.

RESULTS

The predominant prescription by most Western herbal practitioners in Australia is individualised herbal formulae rather than the use of single herbs. Traditional preparations of herbals such as teas and powders are used but liquid herbal extracts are most commonly dispensed. These liquid medicines are in the form of highly concentrated fluid extracts in ratios of 1:1 or 1:2, herb material to liquid. Pre-formulated tablets or capsules made by herbal manufacturers are being incorporated into modern practice but most prescriptions are individualised liquid formulae prepared and dispensed, from the clinic dispensary, after patient consultation. In addition to internal prescriptions, topical creams, pessaries, douches, gargles, eyebaths and poultices or washes are still incorporated into treatments. Although there is variation in used dosage ranges, the predominant system is that of pharmacologically active doses of highly concentrated fluid extracts.

CONCLUSION

The professional prescription of Western herbal medicines is different to commercial usage. As opposed to pre-formulated tablets, or use of single herbals, the vast majority of Western herbalists in Australia construct individualised herbal formulations for their patients after consultation. The preferred form of administration of these prescriptions is as highly concentrated liquid herbal extracts in pharmacologically active doses.

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

The purpose of this paper is to explore the possibility that adverse reactions and drug interactions arising from the use of homeopathic and herbal medicines could lead to confusion when adverse reactions to conventional medicines are reported. An extensive literature review was conducted on the occurrence of adverse reactions and drug interactions following the use of homeopathic or herbal remedies, and the potential for these to confound adverse event reporting to conventional medicines considered. The survey demonstrates the potential for herbal remedies and homeopathic products, to produce adverse drug reactions or drug interactions, and shows the scope for potential for confusion with those arising from conventional medicines. There is a need for greater awareness that adverse reactions apparently due to a conventional medicine, might in reality be due to a herbal medicine or a drug interaction between a herbal medicine and a conventional drug, particularly when a health professional is unaware of the extent of a patient's self-medication with alternative therapies.