Pharmacological Effects of Si Wu Tang - Case Study Example

Pharmacological Effects of ‘Si Wu Tang’ Total Number of Words: 2,509 Table of Contents I. Introduction ………………………………………………………………. 3 II. General Facts about Dysmenorrhoea ………………………………… 3 III. Purpose of Si Wu Tang …………………………………………………. 5 IV. Four Major Composition of Si Wu Tang ………………………………. 5 V. Other Clinical Applications and Pharmacological Effects of Si Wu Tang on Each Patient with Specific Health Condition ………. 6 a. Protects the Bone Marrow from Damages Caused by Radiation ………………………………………………………. 6 b. Treats Common Colds and Flu ……………………………. 6 c. Prevents Pre-menstrual Acne ……………………………… 7 d. Improves Hematopoiesis on Patients with Blood Deficiency …………………………………………….. 7 e. Anti-inflammation and Anti-pruritic Effects on Skin ….. 8 VI. Adverse Effects of Si Wu Tang ……………………………………….. 8 a. Increase Women’s Risk of Breast Cancer ……………… 8 VII. Comparison between Si Wu Tang, Similar Herbal Formulas and Western-made Synthetic Drugs ………………………………………… 9 a. Si Wu Tang vs. Western-made Synthetic Drugs ………… 9 b. Modified Si Wu Tang vs. Indomethacin …………………... 9 c. Modified Si Wu Tang vs. Heat Compression …………….. 11 VIII. Conclusion ………………………………………………………………… 11 References ……………………………………………………………………… 13 - 16 Introduction The use of traditional Chinese herbal medicine has become one of the main interests of pharmacological studies all over the world. Normally, Chinese herbal medicine is composed of 3 to 5 different herbs which aim to treat different illnesses. ‘Si Wu Tang’ also known as the ‘Four-Agents-Decoction’ is a good example of Chinese herbal medicine used as a decoction for nourishing the human blood. Si Wu Tang is an eight hundred year old formula that contains four Chinese herbs. Based on the study of a research institute which was conducted among the women in a college for a period of two consecutive years, Si Wu Tang is the most frequently used Chinese medicine for dysmenorrhoea because it could effectively remove menstrual discomfort. (Yeh et al., 2007) For this study, the researcher will first discuss about dysmenorrhoea before explaining the main purpose of Si Wu Tang. Eventually, the researcher will focus on analyzing the four major composition of Si Wu Tang. By conducting a literature review on the main formula behind Si Wu Tang, the researcher will highlight the main composition of Si Wu Tang as well as its clinical applications and pharmacological effects on patients who are experiencing the symptoms of dysmenorrhoea. Prior to the conclusion, the researcher will distinguish and discuss other similar herbal formulas as well as other Western-made synthetic drugs used in treating dysmenorrhoea and compare it with Si Wu Tang. General Facts about Dysmenorrhoea Dysmenorrhoea is one of the most common gynaecological complaint among the adolescent girls and women of reproductive age. (Zhu et al., 2008) Normally, women who are going through the process of dysmenorrhoea often experience painful cramps in the lower abdominal area during the menstruation period. The two classification of dysmenorrhoea includes the primary and the secondary. (Dawood, 2006; Lichten, 1987) Basically, primary dysmenorrhoea occurs when there is no identifiable pathological condition. Normally, primary dysmenorrhoea starts after the period of menarche or the beginning of the ovulation cycle. On the other hand, secondary dysmenorrhoea occurs when menstrual pain is associated with any possible organic pathology such as endometriosis. (Dawood, 2006) Based on some clinical and experimental report, the over production of the uterine prostaglandins as well as the vasopressin is the main cause of menstrual cramps. (Dmitrovic, 2003) In general, oestrogens stimulate the release of vasopressin. Eventually, progesterones functions by controlling the presence of vasopressin. (Forsling, 1985) In case the ovarian hormones is not balance, a woman could experience dysmenorrhoea. (Hauksson, 1987) In Britain, as much as 45 to 95% of women were reported to be complaining about non-specified dysmenorrhoea-related discomfort during their menstrual period. (Zondervan et al., 1998) In line with the high number of women who are experiencing pain and discomfort during their menstrual period, roughly 42 to 51% of these women has been reported to be absent from school or work. (French, 2005; Harlow & Park, 1996) Purpose of Si Wu Tang Si Wu Tang is said to be effective in enriching the blood and regulating the menstruation cycle of young girls and women. (Zhu et al., 2008; Yeh et al., 2007; Kennedy et al., 2006; Proctor & Murphy, 2001; Huang & Xu, 2000; Zhang, 2000) The combination of four major Chinese herbs is commonly used in treating irregular menstruation, lower abdominal pain associated with menstruation cycle, and the formation of blood mass at the time of menstruation period. Aside from treating menstruation-related symptoms, Si Wu Tang is also used in curing symptoms of blood stasis wilting such as atrophy, limpness, difficulty in moving, and pain in the limbs and vessel wilting such as inability to lift the lower limbs or weakness of the legs causing an individual to experience difficulty in standing. (Cohen, Tagliaferri, & Tripathy, 2002) Four Major Composition of Si Wu Tang Originally listed in the Prescriptions of People’s Welfare Pharmacy in China, the four major components of Si Wu Tang include the dry roots of: (1) Radix Rehmanniae praeparata (Soe Dee Huang); (2) Radix Paeoniae Alba (Bai Sau); (3) Radix Angelicae Sinensis (Dang Guay); and (4) Rhizoma Ligustici Chuanxiong (Tsuan Chyong). (Science Daily, 2007; Yeh et al., 2007) These herbs are readily available in Mainland China or some Chinese medicine shops. Based on the original pharmacopoeia, these major herbal components should be prepared in equal proportion and extracted in water using the ratio of 1:13. Other Clinical Applications and Pharmacological Effects of Si Wu Tang on Each Patient with Specific Health Condition Protects the Bone Marrow from Damages Caused by Radiation Aside from treating menstrual related symptoms such as dysmenorrhoea, the study of Hsue-Yin et al. (1996) reveals that the intake of 20 mg per 20g of body weight Si Wu Tang for a total of seven (7) days before irradiation has the ability to protect the bone marrow from damages caused by 1 to 9 Gy dose of radiation. Similar to the research findings of Hsue-Yin et al. (1996), a more recent study conducted by Lee et al. (1999) also reveals that the four major components of Si Wu Tang specifically the extract of Danggui and Baishaoyao may have a major radioprotective effect on human beings. This is primarily because of the fact that the main ingredients of Si-Jun-Zi-Tang was proven to be less effective than Si Wu Tang. Treats Common Colds and Flu Often characterized by symptoms of sore throat, fever and malaise, the four major components of Si Wu Tang are also used in treating the initial stage of common colds and flu among the perimenstrual and pregnant women. (Flaws, 2007) As explained by Han & Huang (2007), the liver and spleen should have sufficient blood flow in order to enable the body to protect itself from external factors that causes symptoms of illnesses. What happens during the menstruation cycle of a woman is that a large volume of blood accumulates in the uterus causing the upper portion of the human body to have insufficient blood flow. (Flaws, 2007) Prevents Pre-menstrual Acne Pre-menstrual acne is often associated with the hormonal imbalance among women. (Doctors Guide News, 2001) Considering the Si Wu Tang can be used to treat hormonal imbalance, this herbs can be used in preventing the development of pre-menstrual acne. According to Brown (2005), a regular consumption of Si Wu Tang herbal soup can be used to counteract not only poor nutrition but also pollution and stress. As a result, a premature skin aging can be easily prevented. Improves Hematopoiesis on Patients with Blood Deficiency The Study of Tan et al. (2005) which was conducted on mice shows that the inducing Si Wu Tang decoction on mice with blood deficiency could significantly improve its hematopoiesis such that the amount of red blood cells had significantly increased from the normal 4.6 x 10(12) to 6.5 x 10(12) when induced by compound method of bleeding; 7.1 x 10(12) when induced by starved feeding; and 7.0 x 10(12) when induced by exhausting. When the mice with blood deficiency were induced with cyclophosphamide (CIX) and Si Wu Tang decoction, the mice could effectively restore as much as 12 up-regulated and 3 down-regulated proteins in the bone marrow. (Liu et al., 2006) Similar to the study results of Liu et al. (2006), the study of Guo et al. (2004) which examined the effects of Si Wu Tang on the protein expression of the bone marrow of mice with blood deficiency induced by radiation concluded that injestion of Si Wu Tang could effectively reverse as much as 10 up-regulated and 4 down-regulated proteins which is important in promoting the growth and differentiation of hematopoietic cells that can enrich its blood functioning. This is primarily because of Si Wu Tang’s capacity to promote the HFCL proliferation and increase cell cycle and protein expression by restoring as much as 12 kinds of up-regulated proteins and down-regulate 5 different kinds of HFCL proteins. Anti-inflammation and Anti-pruritic Effects on Skin The components of Si Wu Tang were clinically proven to be effective in treating cutaneous (skin) pruritis, chronic inflammation of the skin and other skin diseases. Specifically the study of Dai et al. (2002) shows that Si Wu Tang which is composed of 25, 100 microg/ml Paeoniae Radix and 100 microg/ml of Rehmanniae Radix and Cuanxiong Rhizoma has an antipruritic and anti-inflammatory effects when 250, 500 and 1000 mg/kg of Si Wu Tang decoction compound was administered to several mice with skin diseases. Basically, as little as 50 to 500 microg/ml of Si Wu Tang concentration could effectively inhibit the release of histamine from the rat’s peritoneal mast cells. Adverse Effects of Si Wu Tang Increase Women’s Risk of Breast Cancer The study that was recently conducted by Chang et al. (2006) reveals that women who are at risk of having breast cancer should consider that some components of Si Wu Tang could stimulate cell proliferation of MCF7 cells causing the activation of the human epidermal growth factor receptor 2 (HER-2) positive breast cancer as well as the downstream signaling molecules of AKt pathways and estrogen receptor (ER) K1/2. AKt normally occurs when there is either a growth factor dependency or a loss of the regulatory PTEN tumor suppressor gene. (Yu et al., 2001) According to Knowlden et al. (2003), there is a strong need to block the external domain of HER-2 in order to effectively reduce the downstream ER K1/2 MAPK in order to signal the inhibiting cell growth. Comparison between Si Wu Tang, Similar Herbal Formulas and Western-made Synthetic Drugs Si Wu Tang vs. Western-made Synthetic Drugs The study of Yeh et al. (2007) instructed the research participants to take a total dosage of 15 capsules three times per day with warm water for five consecutive days starting from the onset of menstrual cycle or pain. Even though no adverse reactions were detected, the study of Yeh et al. (2007) shows that Si Wu Tang or the use of the Four-Agent-Decoction treatment has a similar effect with the use of Western-made synthetic analgesics used in minimizing the occurrence of menstrual pain. Basically, pharmacological drugs used in treating dysmenorrhoea includes the use of either non-steroidal anti-inflammatory drugs (NSAIDs) to inhibit the release of prostaglandins or the oral contraceptive pills (OCPs) to regulate women’s hormonal imbalance. (Zhu et al., 2008) Aside from the 20 to 25% ineffectiveness of the NSAIDs in treating menstrual cramps (Dawood, 1985), some women prefer not to orally consume synthetic drugs. (Taylor, 2002) For this reason, a lot of women today are searching for alternative herbal medicines to treat the symptoms of dysmenorrhoea. (Proctor, 2001) Modified Si Wu Tang vs. Indomethacin To examine the effects of Si Wu Tang on primary dysmenorrhoea, Huang (2000) conducted a randomised study on a total of 58 participants to determine the effects of the researcher’s self-designed formula on modified Si Wu Tang as compared with the use of Indomethacin on the participants’ stagnation of Qi and blood and the retention of cold and blood stasis. Upon examining the participants’ stagnation of Qi and blood, the researcher used the modified Si Wu Tang which includes: (1) 15g Radix Angelicae Sinesis (Dang Gui); (2) 10g Radix Lingustici Chuanxiong (Chuan Xiong); (3) 10g Radix Paeoniae Latiflorae (Bai Shao); (4) 10g Radix Rehmanntae Glutinosae Conquitae (Shu Di); (5) 10g Rhizoma Cypri Rotundi (Xiang Fu); (6) 15g Semen Persicae (Tao Ren); and (7) 10g Flos Carthami Tinctorili (Hong Hua). On the other hand, the researcher used another set of modified Si Wu Tang including: (1) 15g Radix Angelicae Sinesis (Dang Gui); (2) 10g Radix Lingustici Chuanxiong (Chuan Xiong); (3) 10g Radix Paeoniae Latiflorae (Bai Shao); (4) 10g Radix Rehmanntae Glutinosae Conquitae (Shu Di); (5) 15g Semen Persicae (Tao Ren); (6) 10g Flos Carthami Tinctorri (Hong Hua); (6) 6g Ramulus Cinnamomi Cassiae (Gui Zhi); and (7) 6g Fructus Evodiae Rutaecorpae (Wu Zhu Yu) to examine the retention of cold and blood stasis among the participants. Upon instructing the participants to administer one dose of the modified Si Wu Tang each day for three consecutive days as soon as the menstruation period has started, the experimental result shows that the modified Si Wu Tang has a total effectiveness of 92.4% (30.30% cured cases and 54.55% improved abdominal pain cases) whereas the use of 25mg Indomethacin each day for three consecutive days shows only 76% total effectiveness (8% cured cases and 68% improved abdominal pain cases). Modified Si Wu Tang vs. Heat Compression A similar experimental procedure was conducted by Zhang (2000) on a total of 55 participants to test their blood deficiency and blood stasis. In this study, the researcher divided the participants into two groups. The first group were tested using the modified Si Wu Tang (35 participants) while the second group were tested using heat compression (20 participants). For the modified Si Wu Tang, the researcher used Radix Angelicae Sinesis (Dang Gui); Radix Paeoniae Rubrae (Chi Shao); Radix Rehmanntae Glutinosae Conquitae (Shu Di); and Radix Lingustici Chuanxiong (Chuan Xiong) among others for a period of 2 to 3 consecutive days prior to menstruation period. The experimental result shows that the modified Si Wu Tang has a total effectiveness of 97.14% (77.14% cured cases and 11.43% improved abdominal pain symptoms). The second group that was assigned to use heat compression were instructed to start the heat compression as soon as the pain begins for a consecutive period of ten days. The controlled study reveals only 10% total effectiveness. Conclusion There are many pharmacological ways of treating the symptoms of menstrual discomfort. Among the common Western-made pharmaceutical drugs include the use of either non-steroidal anti-inflammatory drugs (NSAIDs) to inhibit the release of prostaglandins or the oral contraceptive pills (OCPs) to regulate women’s hormonal imbalance. (Zhu et al., 2008) Since a large population of women are hesitant to take synthetic drugs, the need to search for alternative drugs such as the use of herbal medicine has gained importance. Si Wu Tang is one of the most commonly used Chinese herbal medicine in treating menstrual cramps and other illnesses related to blood deficiency. Even though the four major components of Si Wu Tang include the dry roots of: (1) Radix Rehmanniae praeparata (Soe Dee Huang); (2) Radix Paeoniae Alba (Bai Sau); (3) Radix Angelicae Sinensis (Dang Guay); and (4) Rhizoma Ligustici Chuanxiong (Tsuan Chyong) (Science Daily, 2007; Yeh et al., 2007), there is practically no basic rule that prohibits the combination of these four major components with other Chinese herbal medicine. We have clearly seen the improved effect of modifying the original Si Wu Tang in terms of curing and improving the symptoms of abdominal pain based on the individual experimental study of Huang (2000) and Zhang (2000). Several clinical and experimental research studies were able to prove the effectiveness of Si Wu Tang in terms of protecting the bone marrow from damages caused by radiation; treats common colds and flu; prevents pre-menstrual acne; improves hematopoiesis on patients with blood deficiency; and its anti-inflammation and anti-pruritic effects on the skin. However, the use of Si Wu Tang is still subjected to further study because of its adverse effects related to increasing the women’s risk of having a breast cancer. *** End *** References: Brown, R. (2005, November / December). Nexus Colorados Holistic Journal. Retrieved April 18, 2008, from Journeys in Health, Healing and Our Search for Meaning: http://www.nexuspub.com/journeys/natural_beauty.htm Chang, C.-J., Chiu, j.-H., Tseng, L.-M., Chang, C.-H., Chien, T.-M., Chen, C.-C., et al. (2006). Si-Wu-Tang and Its Constituents Promote Mammary Duct Cell Proliferation by Up-Regulation of HER-2 Signaling. Menopause , 13(6):967 - 976. 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