Varro E. Tyler’s research while affiliated with Purdue University West Lafayette and other places

Arthur E. Schwarting is the person primarily responsible for the conversion of pharmacognosy from a descriptive botanical discipline to a dynamic biological-biochemical science beginning some 50 years ago. In an effort to understand the reasons for this revolutionary change, it was deemed of interest to examine some of the various factors, both proximate and remote, that may have influenced his actions. Schwarting's professors and their professors were obviously an important element in this development. Consequently, this paper explores his academic forebears back through some of the most famous names in American pharmaceutical eduction to distinguished European scientists and educators. They include one Nobel Laureate, Otto Wallach.

The plant kingdom is replete with compounds and mixtures of compounds that have a stimulating or calmative effect on the central nervous system (CNS). In cases where this action is due to a single high-potency compound that can be chemically isolated, such as morphine, cocaine, or atropine, the plant and its preparations are usually considered to be outside the realm of phytotherapy (see Sect. 1.2). Herbs that contain caffeine are discussed in Sect. 3.2.1.1. Most other herbs affecting the CNS fall under the broad heading of plant sedatives. However, recent controlled therapeutic studies have identified fairly specific indications for three of the psychotropic medicinal plants and their phytomedicinal preparations. Thus, ginkgo biloba extract is considered a nootropic agent that is effective in the symptomatic treatment of cognitive deficiencies (Hartmann and Schulz, 1991; Schulz et al. 1997; Le Bars et al., 1997; Ernst and Pittler, 1999; ESCOP, 2003). Extracts from St. John’s wort have proven highly effective in the treatment of mild to moderate depression and have even shown value in severe depressive disorders (Linde et al.,1996; Wong et al.1998; Kasper, 2001; Schulz, 2002), and extracts from the kava root (Piper methysticum rhizome) have shown efficacy as anxiolytic drugs (Volz and Hansel, 1994; Volz, 1997; Pittler and Ernst, 2000).

Phytomedicines play a significant role in the treatment of mild forms of heart failure and coronary insufficiency, in the prevention and treatment of atherosclerosis and its sequelae, and in the symptomatic treatment of chronic venous insufficiency. There are only a few herbal preparations, however, for which safety and efficacy have been adequately proven: hawthorn leaf and flower extract (heart failure and coronary insufficiency), garlic (atherosclerosis), ginkgo extract (peripheral arterial occlusive disease), and horse chestnut extract (chronic venous insufficiency). Therefore, the bulk of this chapter is devoted to these four herbs and their preparations. The closing sections deal briefly with other preparations, including herbs that contain cardioactive digitaloids and herbal remedies for angina pectoris, cardiac arrhythmias, and hypertension and hypotension.

This book is a practice-oriented introduction to phytotherapy. Methodically classified by organic systems and fields of application, it offers a quick insight into dosage, form of application and effects of the most important herbal remedies. Only those herbal remedies that are of pharmacological and clinical efficiency have been considered. The authors are highly experienced in the field of postgraduate medical education, and, with this work, present an indispensable reference book for the medical practice. All practitioners and pharmacists interested in treatment with herbal remedies should have this book at their disposal.

PC-SPES is a potent eight-herb formulation sold directly to consumers; it has promising efficacy in the treatment of prostate cancer (CaP). The product induces a castrate status in most, if not all, men, resulting in a 50% or greater prostate-specific antigen reduction in the great majority of men with androgen-dependent CaP and in more than one half of the men with androgen-independent CaP. The duration of response is not yet clear. The efficacy of PC-SPES appears to exceed that of androgen ablation alone, but is not necessarily separate from an estrogenic effect. Common side effects include gynecomastia, nipple tenderness, loss of libido, and impotency; uncommon side effects include a 4% incidence of thromboembolic phenomena, but also two reports of bleeding diatheses. The mechanisms of action may involve downregulation of the androgen receptor, induction of apoptosis by way of inhibition of the bcl-2 gene, and increased expression of p53. Two marker compounds in PC-SPES are baicalin and oridonin, both of which exhibit antiproliferative effects in CaP cell lines. Thousands of men are currently obtaining this nonprescription medicine, and physicians should ask patients specifically about its use. PC-SPES is of great interest in men with androgen-independent CaP, an area in which future research should be primarily directed.

To determine the effects of a saw palmetto herbal blend (SPHB) compared with finasteride on prostatic tissue androgen levels and to evaluate needle biopsies as a source of tissue for such determinations. Prostate levels of testosterone and dihydrotestosterone (DHT) were measured on 5 to 10-mg biopsy specimens (18-gauge needle cores) in three groups of men with symptomatic benign prostatic hyperplasia: 15 men receiving chronic finasteride therapy versus 7 untreated controls; 4 men undergoing prostate adenomectomy to determine sampling variability (10 specimens each); and 40 men participating in a 6-month randomized trial of SPHB versus placebo, before and after treatment. Prostatic tissue DHT levels were found to be several times higher than the levels of testosterone (5.01 versus 1.51 ng/g), that ratio becoming reversed (1.05 versus 3.63 ng/g) with chronic finasteride therapy. The finasteride effect was statistically significant for both androgens (P <0.01), and little overlap of individual values between finasteride-treated and control patients was seen. In the randomized trial, tissue DHT levels were reduced by 32% from 6.49 to 4.40 ng/g in the SPHB group (P <0.005), with no significant change in the placebo group. For control versus finasteride-treated men, the tissue androgen values obtained with needle biopsy specimens were similar-both for absolute values and the percentage of change-to those previously reported using surgically excised volumes of prostatic tissue. The quantification of prostatic androgens by assay of needle biopsies is thus feasible and offers the possibility of serial studies in individual patients. The SPHB-induced suppression of prostatic DHT levels, modest but significant in a randomized trial, lends an element of support to the hypothesis that inhibition of the enzyme 5-alpha reductase is a mechanism of action of this substance.

A brief discussion of the history of the use of herbal medicines from prehistoric times to the mid-twentieth century precedes an explanation of why usage of such remedies in the United States declined in the 1940s but returned to popularity in the 1980s. The provisions of the Dietary Supplement Health and Education Act of 1994 are presented together with its perceived influence, both positive and negative, on the health of the American people. Possible futures of herbal medicines are considered. The negative viewpoint that they will ultimately be rejected is refuted, and the more optimistic prediction that herbs are ultimately destined to become a part of mainstream medicine is defended. Stumbling blocks to such acceptance are evaluated and methods of overcoming them suggested. The urgent need for the development of a sensible regulatory environment encouraging the approval of botanicals as drugs is emphasized. After predicting a bright future for rational phytomedicines, the author opines that many of them will eventually play significant roles in medicinal practice.

Purpose: We tested the effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia (BPH) via a randomized, placebo controlled trial. Materials and methods: We randomized 44 men 45 to 80 years old with symptomatic BPH into a trial of a saw palmetto herbal blend versus placebo. End points included routine clinical measures (symptom score, uroflowmetry and post-void residual urine volume), blood chemistry studies (prostate specific antigen, sex hormones and multiphasic analysis), prostate volumetrics by magnetic resonance imaging, and prostate biopsy for zonal tissue morphometry and semiquantitative histology studies. Results: Saw palmetto herbal blend and placebo groups had improved clinical parameters with a slight advantage in the saw palmetto group (not statistically significant). Neither prostate specific antigen nor prostate volume changed from baseline. Prostate epithelial contraction was noted, especially in the transition zone, where percent epithelium decreased from 17.8% at baseline to 10.7% after 6 months of saw palmetto herbal blend (p <0.01). Histological studies showed that the percent of atrophic glands increased from 25. 2% to 40.9% after treatment with saw palmetto herbal blend (p <0.01). The mechanism of action appeared to be nonhormonal but it was not identified by tissue studies of apoptosis, cellular proliferation, angiogenesis, growth factors or androgen receptor expression. We noted no adverse effects of saw palmetto herbal blend. When the study was no longer blinded, 41 men elected to continue therapy in an open label extension. Conclusions: Saw palmetto herbal blend appears to be a safe, highly desirable option for men with moderately symptomatic BPH. The secondary outcome measures of clinical effect in our study were only slightly better for saw palmetto herbal blend than placebo (not statistically significant). However, saw palmetto herbal blend therapy was associated with epithelial contraction, especially in the transition zone (p <0.01), indicating a possible mechanism of action underlying the clinical significance detected in other studies.