By Narda Robinson, DVM, DO, MS, FAAMA

Chances are, if you’ve attended a continuing education course given by a promoter of Chinese herbs, you’ve been told about the countless benefits of the plant Pinellia ternata.

You also may have been told that you can easily start recommending a handful of formulae in everyday practice.¹ After all, the recommendations make it sound easy—“If it is hot, cool it; if it is cold, heat it; if it is dry, moisten it; if it is wet, dry it.”

For the more complex ideas, one can graduate to “If it is deficient, tonify it; if it has excess, sedate/drain it; if it is stagnant, move it.”²

Practice Due Diligence

Likely, the products you are told are safe and effective have never been shown to be either in rigorous trials. Naturally, you have questions and probably hunger for something scientific—a rational mechanism, a published, peer-reviewed paper, a word about potential side effects or other untoward results.

Not only do you have your patients’ health in mind, but you also would like to keep your veterinary license healthy and active as well. This means that you need to employ due diligence and learn more than metaphors insofar as how Chinese mixtures affect the body and the mind.

Let’s look at pinellia as an example. The rhizome or tuber of this plant appears in many formulae touted for a wide range of conditions. One such mixture is Minor Blupleurum Combination, which supposedly can treat “hypoadrenocorticism, encephalitis, lymphoma, chronic active hepatitis, pneumonia, pyelonephritis, glomerulonephritis, Lyme disease, hip dysplasia, partial ACL tear, hind limb paralysis and flank pain.”³

Even if any of these conditions really did improve based on the effects of the mixture, wouldn’t we want to know how it worked and why?

Scientists are, fortunately, analyzing Traditional Chinese Medicine (TCM) herbal ingredients for active constituents to legitimately explain their mechanisms of action. Because TCM medicinals rarely include only single herbs, some researchers are applying network pharmacology approaches to investigate the complex mechanisms involved.⁴ 

One pinellia-containing formula under investigation is called ChuanbeiPipa Dropping Pills (CBPP), recommended for the treatment of pulmonary disease. TCM practitioners claim it has “had good clinical therapeutic effects for eliminating cough, phlegm, chronic bronchitis and inflammation of the lungs.”⁵

Physiologic Pathways

To better expose the effects of CBPP on target tissues and physiologic pathways, Tao et al identified six representative ingredients from four herbs within the product, including guanosine from pinellia. They found that 15 physiologic pathways were affected, most relating to immune or inflammatory processes. This then allowed them to consider how the complex network of signaling pathways implicated in airway inflammation is altered by specific plant compounds.

For pinellia in particular, researchers learned that this plant may reduce sputum production and inflammation at least in part by affecting the focal adhesion-signaling pathway.

At another Chinese herb lecture, you might learn that pinellia treats vomiting in cancer patients that have Spleen Qi Deficiency and Stomach Qi Stagnation.⁶ The speaker may advocate a Chinese herbal prescription called Six Gentleman Decoction that contains pinellia in addition to five other plants. There may be no mention of adverse effects or other potential problems. Does this mean that there’s nothing to worry about?

Unfortunately, no.

As it turns out, recent research out of China indicates that pinellia preparations have the capacity to significantly inhibit the cytochrome P450 enyzme family CYP3A in a rodent model.⁷ Pinellia administration can lead to “marked and consistent down-regulation” of CYP3A activity. Co-administration of pinellia with other xenobiotics (e.g., drugs) that are substrates for CYP3A4 could cause blood concentrations of those compounds to increase or decrease, depending on the chemical.

In the authors’ words, “Results of this study revealed that drug interaction between Pinelliae Rhizoma and the CYP3A- metabolizing drugs might be probable, suggesting that careful monitoring is essential for the concomitant use of PR with other drugs to avoid the adverse interactions.”

Potential Side Effects

Which chemotherapy drugs could be affected by pinellia? At least 20, including doxorubicin, vinblastine, vincristine, cyclophosphamide, tamoxifen and paclitaxel.⁸ Do any of these names ring a bell?

Oh, and what about your fragile cardiac patients? Perhaps you remember that in 2004 the FDA banned dietary supplements, such as Ma Huang (ephedra), that contain ephedrine alkaloids. This included Pinellia ternata.

As stated by the Natural Medicines website,⁹ “Pinellia ternata contains ephedrine alkaloids and is banned in the U.S. [citing final rule from 2004].¹⁰ There is no reliable evidence available about the safety of Pinellia ternata in humans. Because it contains ephedrine alkaloids, it is likely that Pinellia ternata might potentially cause the adverse effects reported with ephedra, including heart attack, stroke, seizure, and other serious side effects.”

Great Unknowns

Finally, a word about dose. No matter what you read or hear about recommended amounts of herbs to administer,¹¹ rigorous research documenting the safety and effectiveness of plants at these dosages across species does not exist. Even if you decided to prorate the dose from the human standard, the Natural Medicines database reports there is “no typical dosage.”¹²

In other words, there is no evidence for the safety and effectiveness of pinellia even in the human.

All this points to the fact that what you don’t know can hurt you, and it can hurt your patients.

When will the veterinary profession hold Chinese medicine practitioners to the same standard that we should all be expected to reach—one built on science, informed by evidence and infused with a responsible regard for the safety and welfare of those in our care?

References

1. Day LK. Integrating Chinese Medicine into everyday practice: 8 herbal formulas to start using now. Kentucky Veterinary Medical Association. 101st Conference. Oct. 5-7, 2012.
2. Day LK. Integrating Chinese Medicine into everyday practice: 8 herbal formulas to start using now. Kentucky Veterinary Medical Association. 101st Conference. Oct. 5-7, 2012.
3. Day LK. Integrating Chinese Medicine into everyday practice: 8 herbal formulas to start using now. Kentucky Veterinary Medical Association. 101st Conference. Oct. 5-7, 2012.
4. Tao J, Hou Y, Ma X, et al. An integrated global chemomics and system biology approach to analyze the mechanisms of the traditional Chinese medicinal preparation Eriobotrya japonica – Fritillaria usuriensis dropping pills for pulmonary diseases. BMC Complementary and Alternative Medicine. 2016; 16(4). DOI: 10.1186/s12906-015-0983-y.
5. Tao J, Hou Y, Ma X, et al. An integrated global chemomics and system biology approach to analyze the mechanisms of the traditional Chinese medicinal preparation Eriobotrya japonica – Fritillaria usuriensis dropping pills for pulmonary diseases. BMC Complementary and Alternative Medicine. 2016; 16(4). DOI: 10.1186/s12906-015-0983-y.
6. Todd G. A Traditional Chinese Veterinary Medical approach to neoplastic disease. Wild West Veterinary Conference. 2013.
7. Wu J, Cheng Z, He S, et al. Pinelliae rhizoma, a toxic Chinese herb, can significantly inhibit CYP3A activity in rats. Molecules. 2015;20:792-806.
8. Horn JR. Get to know an enzyme: CYP3A4. Pharmacy Times. Sept. 1, 2008. Accessed at http://www.pharmacytimes.com/publications/issue/2008/2008-09/2008-09-8687 on 12-27-16.Natural Medicines. Pinellia ternata. Last reviewed on 1/2/13 and last updated on 5/27/15. Accessed at https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1093 on 12-27-16.
9. Food and Drug Administration, HHS. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Final rule. Fed Regist. 2004;69(28):6787-6854.
10. Marsden S. Cancer: An integrative approach. Australian Veterinary Association Proceedings 2013.
11. Natural Medicines Comprehensive Database website. Accessed at http://naturaldatabase.therapeuticresearch.com/Content.aspx?page=aboutdbhtml&xsl=generic on 12-27-16.

Dr. Narda Robinson is president and CEO of CureCore Integrative Medicine and Education Center in Fort Collins, Colo. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. 

Originally published in the February 2017  issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!