Article

Herbal medicine in acute care medicine: past, present, and future?

Editorial

Herbal medicine in acute care medicine: past, present, and future?

Joseph Varon MD?

The University of Texas Health Science Center at Houston, St. Luke’s Episcopal Hospital, Houston, TX 77030, USA The University of Texas Medical Branch at Galveston, St. Luke’s Episcopal Hospital, Houston, TX 77030, USA

Received 3 September 2008; accepted 3 September 2008

Throughout medical history, clinicians have used herbal medications for a variety of ailments. Nowadays, comple- mentary and Alternative medicine (CAM) based on Herbal preparations is commonly used across the world and not uncommonly encountered even in the emergency department (ED) setting. Indeed, the use of CAM has become such a common practice that a survey in the United States revealed that 42% of the adult population consulted regularly alternative medical practitioners and spent more than US

$27 billion per year on alternative medical therapies [1]. An exponential rise in the use of CAM, especially the use of herbal remedies, has been seen in Western countries over the past 10 years. Indeed, many patients presenting to the ED are routinely taking herbal components before their visit [2]. What is even more interesting is that in many instances, either the patient or a family member requests that these herbal preparations are continued during their hospital stay [3].

An interesting point, not familiar to many acute care practitioners, deals with the regulations of these herbal preparations. For example, in the United States, herbal medications are not subject to the Food and Drug Admin- istration regulations. In 1994, the United States congress approved the Dietary Supplement Health and Education Act, defining a dietary supplement as a product containing any of the following: vitamin, mineral, amino acid, herb, or other botanical concentrate [4]. Based on this Act, herbal products

* The University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Tel.: +1 713 669 1670; fax: +1 713 669 1671.

E-mail address: [email protected].

can make health claims on their labels as long as it is printed that there is no intention to treat, cure, or diagnose a specific disease. Moreover, most of these agents do not have to undergo multiple human clinical trials to prove their efficacy or safety. Because of this present lack of regulation, it is very difficult to ascertain their efficacy or even undesirable side effects. Herbal medications are available to anybody that can pay for them as no health insurance plan will cover their cost. The American Journal of Emergency Medicine has previously published reports about the use of different types of CAM in the ED setting [5]. In addition, AJEM has published randomized controlled clinical trials about the use of specific CAM techniques [6]. In this issue of AJEM, Wang and collaborators [7] present an extraordinary review of herbal medications including the present and future treatment

with these preparations of septic shock.

For acute care practitioners, what would motivate them to try herbal medications in patients with septic shock? Could it be the fact that despite 50 years of aggressive septic shock research, our mortality rates remain basically unchanged [8]? Even those survivors of septic shock are observed to have a higher 6 and 12 monthly mortality rate and a significantly lower health-related quality of life [9]. Sepsis and septic shock remain common maladies seen in the ED, and practitioners deal with them on a daily basis. Having patients die despite our best heroic efforts to treat their septic shock discourages the use of conventional medicine in some. There is clearly enough basic science data to support the use of many herbal medications in the complementary management of septic shock.

0735-6757/$ – see front matter (C) 2009 doi:10.1016/j.ajem.2008.09.006

114 Herbal medicine

Sepsis and septic shock are manifestations of a continuum of a systemic inflammatory response in the body. In an experimental animal study, Sakaguchi and associates [10], using a traditional Chinese herbal preparation (Sho-saiko-to), demonstrated the protective effects of this agent in endotoxemia. Chen and coauthors [11] have shown that Green tea reduced Proinflammatory cytokine in patients with sepsis. Some of the healing properties of some herbal compounds (including green tea) are attributed to a series of polyphenolic compounds known as catechins [12].

Although CAM has been in use for millennia, the widespread use of herbal compounds in the prevention and treatment of many illnesses, such as sepsis and septic shock, remains in its infancy. Randomized controlled trials are almost impossible to be performed in Western civilizations because of strict institutional review boards that will not allow such comparisons (ie, when using herbal medications in those clinical entities in which conventional medicine offers some for of therapy that has been proven to be successful in some cases). Comprehensive reviews, like the one presented by Wang and associates, should encourage many of us to do more clinical trials using these compounds.

References

  1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280: 1569-75.
  2. Allen R, Cushman LF, Morris S, et al. Use of complimentary and alternative medicine among Dominican emergency department patients. Am J Emerg Med 2000;18:51-4.
  3. Acosta P, Varon J. Herbal remedies in the ICU: guaranteed results or trouble for sure? Crit Care Shock 2007;10:2-3.
  4. Goldman P. Herbal medicines today and the roots of modern pharmacology. Ann Intern Med 2001;135:594-600.
  5. Zun LS, Gossman W, Lilienstein D, Downey L. Patients’ self- treatment with alternative treatment before presenting to the ED. Am J Emerg Med 2002;20:473-5.
  6. Lang T, Hager H, Funovits V, et al. Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial. Am J Emerg Med 2007;25:887-93.
  7. Wang D, Xu T, Lewin M. Future possibilities for the treatment of septic shock with herbal components. Am J Emerg Med 2008.
  8. Varon J, Acosta P. Is the mortality in the emergency department Sepsis score a reliable Predictive tool for the ED physician? Am J Emerg Med 2008;26:693-4.
  9. Heyland DK, Hopman W, Coo H, et al. Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. Crit Care Med 2000;28: 3599-605.
  10. Sakaguchi S, Furusawa, Iizuka Y. Preventive effects of Traditional Chinese Medicine (Sho-saiko-to) on septic shock symptoms; Approached from heme Metabolic disorders in endotoxemia. Biol Pharm Bull 2005;28:165-8.
  11. Chen X, Li W, Wang H. More tea for septic patients? – Green tea may reduce endotoxin-induced release of high mobility group box 1 (HMGB1) and other pro-inflammatory cytokines. Med Hypotheses 2006;66:660-3.
  12. Graham HN. Green tea composition, consumption, and polyphenol chemistry. Prev Med 1992;21:334-50.

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