Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine.

BACKGROUND: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, characterised by thickening of the wall of the right hemicolon with calcification of mesenteric veins. However, the aetiology remains unknown. AIM: To investigate the possible association of herbal medicines with IMP. METHOD: The clinical data of four of our own patients were collected. Furthermore, we searched for previous reports about similar patients with detailed descriptions of herbal prescriptions that they had taken. We compared herbal ingredients to identify the toxic agent as a possible aetiological factor. RESULTS: Clinical data on a total of 25 patients were summarised. Mean age was 61.8 years and there was female predominance (6 men and 19 women). The used Kampo prescription, the number of cases, and the mean duration of use were as follows: kamisyoyosan in 12 cases for 12.8 years, inshin-iseihaito in 5 cases for 13.4 years, orengedokuto in 4 cases for 14.3 years, inchinkoto in 1 case for 20 years, kamikihitou in 1 case for 19 years, seijobofuto in 1 case for 10 years and gorinsan in 1 case for an unknown duration. Only one ingredient, sansisi, was common to the herbal medicines of all 25 patients. This crude drug called geniposide in English is a major constituent of the Gardenia fruits. CONCLUSION: The long-term use of geniposide in herbal medicines appears to be associated with mesenteric phlebosclerosis.

Clinical and immunomodulatory effects of fun-boi, an herbal medicine, on collagen-induced arthritis in vivo.

OBJECTIVE: Crude preparations of Fun-boi (Stephania tetrandra), a traditional antirheumatic herb, have been reported to have immunomodulatory effects on both cell-mediated and humoral immunity in vitro, but little is known about the mode of action in vivo. The objective of this study was therefore to evaluate the efficacy of Fun-boi against arthritis and its effect on the immune system. METHODS: Mice were divided into the following 3 groups of 7 mice each: 1) a normal group, not treated to cause collagen-induced arthritis (CIA), received water orally; 2) a control group with CIA received water orally; and 3) the Fun-boi group with CIA, received Fun-boi (3 mg/g body weight/day) orally. We analyzed the arthritis score, the serum anti-type II collagen (CII) antibody level, and the percentage of the following lymphocyte subsets from lymphoid organs: B220, CD3/CD4, CD3/CD8 and CD40L/CD4 lymphocytes from blood or lymph nodes; and CD4-CD8-, CD4+CD8+, CD4+CD8- and CD4-CD8+ from the thymus. RESULTS: Fun-boi therapy markedly reduced the severity of arthritis (p < 0.001) and tended to reduce the serum anti-CII antibody level (p = 0.06). Whereas CII immunization of DBA/1J mice caused a significant redistribution of CD3/CD8 lymphocytes from blood or lymph nodes, Fun-boi therapy caused significant normalization of the same types of lymphocyte subsets from lymph nodes, but did not affect the CD4 or CD4/CD40L lymphocyte subsets. CONCLUSION: These results demonstrate that Fun-boi therapy exerts therapeutic effects in CIA mice, possibly by causing immunomodulatory effects at specific sites.

Clinical and Immunomodulatory Effect of Fun-boi, an Herbal Medicine, in Rheumatoid Arthritis.

Crude preparations of Fun-boi (Fen-fan-ji in Chinese), a traditional anti-rheumatic herb, have been used safely over millennia. To begin to study the efficacy of Fun-boi on the disease activity and the peripheral lymphocyte subsets, we performed a 12-week, open-label trial of Fun-boi extract (a decoction of Fun-boi 10 g/day) in 29 patients with rheumatoid arthritis (RA). Most clinical and immunological variables: swollen joint count, physician's and patient's assessment, pain score and IgM rheumatoid factor, showed statistically significant improvement. Seven (24%) of the enrolled patients met the American College of Rheumatology (ACR) criteria for a 20 percent improvement in measures of disease activity (ACR20) and 3 (10%) met those for ACR50. The CD3+CD8+ lymphocytes were increased significantly. Accordingly, the CD4/CD8 ratio was decreased; however, these changes did not show any clear correlation with clinical response. Two patients (7%) experienced some minor transient adverse events. In conclusion, Fun-boi is safe and showed beneficial effect in some patients for the treatment of the relatively mild RA seen in the patients studied. Further controlled studies are indicated. Clinicians should keep an open mind about possible benefits of these still incompletely studied herbal agents.

[Investigation of Cryptomeria japonica pollinosis in Izu-Oshima].

We surveyed by questionnaire 4,673 residents of Izu-Oshima who were 15 or more years of age with regard to Cryptomeria japonica pollinosis. The response rate was 22.3%. In the early spring, nasal symptoms were reported by 8.9% of the respondents, ocular symptoms by 5.7%, and dermal symptoms by 8.1%. On scratch tests of symptomatic subjects, 13.8% were positive for Cryptomeria japonica antigen, and 33.3% had an IgE RAST score of 2 or more. The peak Cryptomeria japonica pollen concentrations between February and April 1990 were 118/cm2 on March 7 at the Northern Clinic and 271/cm2 at the Southern Clinic. A second questionnaire survey (response rate: 53.1%), designed to estimate the number of persons with Cryptomeria japonica pollinosis among all residents, revealed that 4.7% concurrently had three or more nasal symptoms and two ocular symptoms. By combining these results with those of a telephone survey of 100 randomly selected nonrespondents, 5.64% of all inhabitants were estimated to have suspected Cryptomeria japonica pollinosis.